Employee Hardship Fund Request Form

Visit aub.ie/hardshipfund for additional information about the Employee Hardship Fund.

Email univhr@auburn.edu if you have accommodation requests or accessibility needs.

Applicant Information

Date*

Employee Last Name*

Employee First Name*

Employee Email Address*

Employee Banner ID Number*

Begins with 90

Hire Date*

Department Name*

Work Phone Number*

Phone

Alternative Phone Number

Phone

Request Information

What was/is the specific hardship event(s)?

IMPORTANT: If the event(s) involved someone other than yourself, please include that in your answer, including how the individual(s) is related to you. If you need additional space, please upload your information at the bottom of this form.

Please completely describe why you need assistance, focusing on the event(s) you mentioned in the previous question.*

If you need additional space, please upload your information at the bottom of this form.

How much assistance are you requesting?*

Please type a specific dollar amount.

Have you received assistance from the Hardship Fund in the past?*

Select or enter value

If you answered "Yes" to the previous question, please explain when and why:

Documentation Upload

Please upload any relevant documentation to your request. This documentation should support the amount that you are requesting.

Documentation may include but is not limited to:

Certification of medical condition
Certified death certificate
Obituary
Medical bill(s)
Insurance claims
Police reports
Expense receipts
Foreclosure or eviction notices.

Refer to the Auburn University Hardship Policy for further information.

Drag and drop files here or

For More Information

Call Auburn University Human Resources at (334) 844-4145 or email univhr@auburn.edu if you have questions.

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