Emergency Aid Application

(Viking Student Email Preferred)

House Number & Street

(If different from local address). Full address including city, state & zipcode

Example: Nursing, Accounting, Mathematics, Welding, etc.

Example: Spring 2026

If it is determined that you are eligible for emergency aid what is your preferred disbursement method?

Please explain your efforts to seek resources for assistance (family, other agencies, churches, other campus resources, etc.)

Will the unexpected expense affect your ability to attend class or remain enrolled at Grayson College?

Thank you for submitting the Grayson Cares Emergency Aid Application. To qualify for funding, you must provide one or more billing statements for the aid you are requesting. The billing statement(s) may be a screenshot, PDF, photo or scanned image.

The billing statement(s) must include the following information:

• Your first and last name OR billing address matching the address we have on file for you at Grayson College
• Provider’s name and/or contact information
• Amount owed
• Due date

Provide additional description of your attachments if needed.

I grant permission to Grayson Cares and/or the Director of Counseling and Social Services to release/obtain information to/from partnering community agencies/businesses in order to help me receive assistance. I understand that if I do not grant permission to share information with community partners, emergency assistance may be limited or unavailable.