Emergency Fund Request Form
The purpose of the fund is to provide financial assistance to students who are faced with an emergency hardship that impacts their ability to continue their studies. Examples of qualifying needs include but are not limited to:
*medical or dental expenses not otherwise covered by insurance
*travel to the funeral of a family member; travel for urgent family matter
*sudden loss of income or housing emergency
*loss due to theft or fire
*recovery from an illness or accident
Requests for emergency funds will be considered on a case by case basis. If you require immediate assistance please contact Angelica Cuevas at (626)395-6346, or firstname.lastname@example.org, to set up an appointment to speak to a Dean.
Non-urgent requests will take about 5-8 business days to receive a decision. For medical or dental expenses we urge you to first contact Kevin Lee in HR, Student Benefits Specialist, at email@example.com to discuss your coverage.
Please provide an explanation of the request below and be sure to indicate if this will be a refund.
Please attach any supporting documentation.