EmailMe Form - Covid Fund Application-Current Promise Scholar

Name *

First Last

Date of Birth *

MM / DD / YYYY

Email *

Phone- Cell is preferred *

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

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Parent/Guardian Name

First Last

Parent/Guardian Phone

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

High school graduation year *

Will you be able to successfully complete your current semester and earn all your credits? *

Yes

No

If not, what prevents you from completing the semester and earning your credits?

Will you finish your semester without owing your college any money? *

Yes

No

If not, list the amount you owe. How do you plan on paying off your balance before the fall semester?

Are you planning to re-enroll in the fall semester? *

Yes

No

If yes, where will you re-enroll?

Has COVID-19 interrupted your plans to find a job or internship? *

Yes

No

If yes, what resources did you rely on that are challenging to rely on now?

Are you getting enough food at this time? *

Yes

No

Sometimes

Are there any immediate and serious needs you are facing currently? *

How will support from the emergency fund help you finalize your plans for the fall of 2020? *