Emergency Fund Request Form
The purpose of the fund is to provide emergency financial assistance to students who are faced with a financial hardship that immediately 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 a housing emergency
*loss due to theft or fire
*recovery from a recent illness or accident
Requests for emergency funds will be reviewed on a case-by-case basis, and students must be in good academic standing to be considered. Expenses for incidents that occurred earlier than 12 months from time of request are not eligible. Awards are contingent on the availability of funds. If you require immediate assistance please contact us at email@example.com to set up an appointment to speak to a Dean.
Non-urgent requests will take about 10-12 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 firstname.lastname@example.org to discuss your coverage.
Please note, only enrolled students in good standing qualify. Due to limited resources we are unable to provide support for any emergencies impacting a student's partner, spouse, child, or other family member. Legal fees are not eligible for consideration.
Please provide a brief explanation of the request below.
Please attach any supporting documentation. The document, bills, and/or invoices must contain a date of service and any insurance applied (if applicable), but personal medical information may be redacted for privacy. If requesting funds for a theft, please include a police report or case number.
Are you requesting a refund or payment of an outstanding balance?
Outstanding balance (I would like direct payment by Caltech on my behalf)
Outstanding balance (I plan to pay myself)
Refund (I already paid)
If your request is approved, and you have an outstanding balance you want us to pay on your behalf, please note that additional information may be required in order to process direct payment.
For medical and dental charges, have you consulted with Kevin Lee in Human Resources?