EmailMeForm
2024 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 Emergency - Check all that apply
*
Housing
Medical/Mental Health
Technological
Unmet Basic Needs (Food, Hygiene, etc.)
Employment
Child-Related
Health-Related
Transportation
Unexpected Expense
Other
If this is a housing emergency, please describe the type of housing expense you're facing.
Eviction Notice
Rent/Mortgage Assistance
Move-In Costs
Other
When did the emergency event occur?
*
Less than 2 months ago
2-5 months ago
More than 5 months ago
Dollar Amount Requested
*
How do you intend to use the funds? Please provide a breakdown of the amount requested.
*
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
How does this emergency impact your ability to complete this quarter of college?
*
Are there any answers that you would like to clarify? Is there any additional information you would like the committee to consider?
Do you foresee any factors OTHER than this emergency that may impact your ability to complete this quarter of college? Check all that apply.
*
Academic
Financial Planning
Local Resource Connection
Other
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
What classes are you taking this quarter?
*
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
Dependent / Living with Parents
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.
I understand that funds are prioritized for those who have not been awarded in the last year. Repeat awards will only be considered if funding is available after others have been considered.
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.
