EmailMeForm
Emergency Grant Application
Please submit the information below to apply for a Student Emergency Assistance Grant.
Name
*
First
Last
ctcLink ID
*
Phone
*
###
-
###
-
####
Email
*
Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Type of Financial Need - Check all that apply
*
Housing/Rent
Utilities
Meals/Groceries
Books/Academic Supplies
Child-Related
Health-Related
Student-Related Technology
Other
Dollar Amount Requested
*
Explanation of Amount
*
Please use this section to itemize your total if you are requesting for multiple expenses.
For example; Total Amount Requested: $500.
$250 for rent
$200 for utilities
$50 for groceries
Please describe the emergency related to this request. Include any information that can help us understand why you are requesting emergency funds.
*
How does this emergency impact your ability to complete this quarter of college?
*
How do you intend to use the funds should you be awarded?
*
Please explain how this emergency situation is temporary. If this is an ongoing expense (such as rent), explain what plans you have arranged to cover this expense in the future.
*
Do you foresee any factors OTHER than this emergency that may impact your ability to complete this quarter of college? Please explain.
*
How likely are you to drop out or take a break from college at this point in time?
*
Please select
Extremely Likely
Very Likely
Likely
Not Likely
Not at all Likely
If you were to receive emergency grant funds, how likely are you to complete the current quarter?
*
Please select
Extremely Likely
Very Likely
Likely
Not Likely
Not at all Likely
If you were to receive emergency grant funds, how likely are you to enroll at CC next quarter?
*
Please select
Extremely Likely
Very Likely
Likely
Not Likely
Not at all Likely
Are you currently enrolled at CC?
*
Yes
No
Additional Resources
We want to ensure you are able to access a variety of services and supports. To best serve you, we want to know if you are receiving assistance from any of the following agencies. This WILL NOT impact your eligibility for assistance.
*
I'm Not Receiving Other Assistance
DSHS Food Benefits
DSHS TANF Grant
Social Security/Disability Benefits
Unemployment Benefits
What is your family status?
*
Single parent with children/dependents
Couple with children/dependents
No children or dependents
Other
If you have children/dependents, how many?
What is your employment status?
*
Employed full-time
Employed part-time
Unemployed, but seeking employment
Unemployed and not seeking employment
How secure is your current housing situation?
*
 
Currently Unhoused
1
2
3
4
5
6
7
8
9
10
 
Stable Housing
How secure is your access to food?
*
 
Not Enough Food
1
2
3
4
5
6
7
8
9
10
 
More Than Enough Food
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 Purposes
*
I acknowledge that I can only use this grant for education-related purposes.
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, to the best of my knowledge.