EmailMe Form - Food Insecurity Application

Name *

First Last

ctcLink ID *

Phone *

### - ### - ####

Email *

Acknowledgement of Tuition Payment *

I acknowledge that I have paid my tuition or am on a payment plan.

To be eligible for funding, your tuition and fees must be paid in full or you must have a payment plan set up for any outstanding balance. Contact Debbie Walker at debbie.walker@centralia.edu or 360-623-8646 for more information on setting up a payment plan.

Acknowledgement of Fund Prioritization *

I understand that funds are prioritized for those who have not been awarded in the last quarter. Repeat awards will only be considered if funding is available after others have been considered.

Acknowledgement of Timeline *

I understand that funds are subject to eligibility and are not guaranteed. Funds may take 2-3 weeks to process.

Certification *

I certify that statements made on this application form are complete and true, and that I am experiencing an unexpected food need.