Emergency Fund Request Form
The purpose of the fund is to provide financial assistance to students who are faced with an emergency hardship that immediately impacts their ability to continue their studies. Examples of qualifying needs include, but are not limited to:
*a student's medical or dental expenses not otherwise covered by insurance
*student travel to the funeral of a family member; travel for urgent family matter
*student's 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 (626)395-6346, or 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 student's qualify; lawyer fees/litigation expenses are not eligible for consideration. Due to limited resources we are unable to provide support for any emergencies impacting a student's partner, spouse, or family member.
Please provide an explanation of the type of request below.
Please attach any supporting documentation. The document, bills, and/or invoices must contain a date.
Are you requesting funds to pay an outstanding balance on a bill?
Refund (I already paid)