Dean of Students: Student In Crisis Fund Application

Dean of Students: Student In Crisis Fund Application

If you are experiencing a financial crisis that may negatively impact your academics, you may be eligible to receive one time financial support from the Students in Crisis Fund. The Students in Crisis Fund was created for currently enrolled, matriculated students who find themselves in a financial crisis that is or has the potential to negatively impact their enrollment and academic success at University of Oregon.

This fund is made possible by generous donations from our UO Duck Community with the hope, purpose, and mission to decrease barriers to academic success when students experience temporary financial concerns. The Students in Crisis Fund is a payer of last resort. Only students who have never received student in crisis funds previously and complete this intake form will be considered.

First Name*

Last Name*

Student ID Number (951xxxxxx)*

Note: Without a valid Student ID number, your intake form will not be reviewed.

University Email*

Note: Without a valid and working UO email address, your intake form will not be reviewed.

Phone Number

If you don’t have a consistent or active phone number, please indicate that below.

Please select the appropriate classification(s) that most represent your student status (check all that apply):*

Please review and acknowledge the eligibility for the students in crisis fund:*

Eligibility for Students in Crisis Funding include:

Students who have never received Students In Crisis Funds;
You must be a matriculated and enrolled students who is facing an emergency financial hardship;
You must be currently enrolled at the University of Oregon for the term the emergency aid is being requested;
If requesting support between terms/semesters, you should have been enrolled during the previous term and enrolled the upcoming term.

I have reviewed the requirements and am eligible for the fund.

Please review the following information about the students in crisis fund:*

Awards greater than $700 will not be approved except in cases of extraordinary need and will typically require supporting documentation prior to disbursement.
This form should not be filled out 'on behalf of' a UO student.
Sufficient documentation of financial hardship may be required, upon request.
The monies awarded shall be determined by the appropriate DOS administrator.
Student in Crisis funds may only be requested once in a student's academic career
Our process from in-take submission to disbursement can take up to 30 days.
Awards from the students in crisis fund count as university provided aid, and could impact your financial aid package. Recipients are responsible for working with the Office of Financial Aid and Scholarships to determine the impact on their financial aid.
Students who have exhausted, or are otherwise ineligible, for federal student aid options may be prioritized for funds.
Examples of expenses NOT COVERED include:
Tuition
Study abroad costs
Application or test fees
Dues for campus organizations
Educational resources that are provided by UO at no additional cost to students. This includes laptops, book costs, and software.
Non-essential utilities (e.g., cable) and general household costs

Select

Current term emergency aid is being requested:*

Select

Intake Questions

How many UO credits are you currently enrolled in this fall term?

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How many UO credits are you currently enrolled in this winter term?

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How many UO credits are you currently enrolled in this spring term?

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How many UO credits are you currently enrolled in this summer term?

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How many UO credits will you plan to enroll in for next term?*

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Please describe the circumstances that have made it necessary for you to complete this intake form and how you would use the funds, if granted.*

Explain how these unexpected expenses might affect your ability to remain enrolled at the University of Oregon.

Amount of funding requested based on needs shared above?*

Note: Include amount requested in US dollars: i.e. $550

How will the funds primarily be used? (check all that apply)?*

Medications or other health-related costs

Rent or other housing expenses

Essential utilities

Books or other essential academic expenses

Personal safety needs (eg. Changing a lock)

Replacement of essential personal belongings due to a natural disaster, fire, theft, or other unforeseen circumstance

Travel costs related to a death or serious illness in your family

Other

Do you currently have housing?*

Yes

Sometimes

Have you completed your FAFSA (Free Application for Federal Student Aid) for this Academic Year?*

Yes

I am not eligible to complete the FASFA

Are you eligible for or participate in the Federal Work-Study program?*

Yes;

Have you applied to any federal emergency funding through the Financial Aid and Scholarship Office?*

Yes

I am not eligible to receive federal emergency funding

If you selected yes to the question above, please indicate if you have received federal emergency funding and include the amount that you were awarded:

Note: Your response will not impact your ability to request student in crisis funding

Have you been awarded Student in Crisis Funds from the Office of the Dean of Students?*

Yes

How much, in total have you received from the student in crisis fund in the past?

Please describe any financial aid or scholarships you are currently receiving:*

Note: Your response will not impact your ability to request student in crisis funding.

What other sources of funding have you tried to obtain?*

Please explain in detail any other funds you have requested or are currently applying for through campus or community resources. Please include any loans, CARES Act Grant, Medicaid, personal financial accounts, community resources, etc. (Note: Your response will not impact your ability to request student in crisis funding)

Please use the section below to provide a specific cost breakdown of your current expenses and how the funds will be used to satisfy these expenses.

The more detailed and specific the information shared with us as part of your initial intake form, the less likely it would require delays due to additional follow up and information that may be needed.

Please describe your employment status as of the last month:*

I am employed on-campus

I am employed off-campus

I am employed on-campus and off-campus

I had on-campus employment

I had off-campus employment

I had jobs both on and off campus

I have not had any paid employment in the past 30 days

How much are you requesting for rent and/or utilities:

What is your average monthly cost of rent and/or utilities (we may ask for additional documentation as part of processing your request):

Do you share the cost of rent with anyone?

Are you currently living in and occupying the space you are requesting rental assistance for the month(s) listed above?

Yes

Situation Documentation

Below you will find the types of documents you may submit for the different types of situations. Please note you only need to submit one document for all other concerns: Job Loss--You may submit notice of your layoff, layoff notice of your significant other, or another supporting family member(s), Loss of childcare provider--You may provide documentation, such as an email or other communication from childcare provider Medical or health event (COVID-19 or other)--You may provide a doctor’s note, medical bill, or prescription etc. Disaster (fire, flooding in apartment, car accident, etc.)--You may submit a incident report, insurance claim, or a relevant document Theft or other crime--You may submit a crime report Other events causing exigent circumstances-- you may submit a document that demonstrates this event. If you don't have or are unable to submit any of the documents above, you may submit an an income vs. expense worksheet: https://www.dropbox.com/s/4lhbagw16nfsnea/UO%20Student%20in%20Crisis%20Fund-%20Income_Expense%20Worksheet.docx?dl=0

Upload documentation here:*

Drag and drop files here or

Please describe how the documentation you submitted connects to your situation?

If granted, how would you like to receive the funds?*

Direct Deposit (Set-Up in Duckweb)

Mailed Check

I understand that recipients of students in crisis funds do not typically receive more than $700.*

Select or enter value

I understand, this funding will count toward my overall financial aid package at the University of Oregon.*

Select or enter value

I understand that if I am awarded funds, I am responsible for contacting the Office of Financial Aid and Scholarships to determine if the approved funds will impact my financial aid.*

Select or enter value

I understand that by completing this intake form, it does not guarantee I will be awarded funds.*

Yes

I affirm that, to the best of my knowledge, the information I’ve provided in this application is complete, true, and accurate.*

Yes

Send me a copy of my responses

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