ONE-TIME STUDENT EMERGENCY FUND APPLICATION

ONE-TIME STUDENT EMERGENCY FUND APPLICATION

Eligibility

I am registered for at least 6 credits for the semester in which I am requesting funds.*

Yes

I have completed at least 12 semester hours as a student at Southwest.*

Yes

Have a minimum 2.0 GPA and 50% credit completion rate and be in good standing.*

Yes

Application Instructions

Complete Student Information and Student Financial Information sections of application form
Attach documentation explaining circumstances

NOTE: This is a ONE TIME ONLY assistance. Documentation must be attached to all requests.

Submit completed application to Southwest Tennessee Community College Office of Institutional Development.

Student Information

Name*

Banner ID*

Address*

Phone(home)*

Phone

Phone(cell)

Phone

Email*

Briefly describe your unforeseen financial emergency or catastrophic event and how these funds will help alleviate your circumstances. Itemize the specific funds needed (daycare, rent, utilities, etc…) Please describe how you will manage your future financial needs (Attach additional page(s) if necessary.*

Amount Requested*

How will you use the funds? (Documentation must be provided. Examples include utility bill, rent statement, mechanical estimates.)*

I affirm that all information on this application is complete, true, and correct and that I am in need of these funds to continue my education at Southwest Tennessee Community College. I am aware that these funds are only available once and that subsequent applications are void. Student Signature*

Student Financial Information

To be completed by the applicant

Are you currently employed?*

Yes

If so,monthly income: $*

Employer Name:*

Marital status*

Number of Dependents:*

Estimated Costs (per month)

Rent/Mortgage

Food

Transportation

Utilities

Child Care

Cell Phone

Cable/Internet

Other expenses

Total Expenses Per Month

Estimated Income (per month)

Earnings of student

Earnings of spouse

Parent’s contribution

Savings

Child Support received

Other resources (Including TANF, DARS,SSI)

Total Income Per Month

Attach Documentation Explaining Circumstances here.*

PDF, JPEG, and image files only. No screenshots

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