Covid-19 Higher Education Emergency Relief Fund Application

First Name: (required)

Last Name: (required)

Mailing Address:

Phone Number:

What increase in expenses have you incurred due to the disruption of Spring Semester 2020 since March 13? Select all that apply.
HousingTechnologyFoodCourse MaterialsTransportationHealth CareChild Care

Other Expenses:

Which of these impacted your education during the Spring 2020 semester? Select all that apply.
You lost your job, you've been furloughed, or you've received fewer hours of work or compensationA significant other whom you rely on for financial support has experienced the situations mentioned aboveYou needed a computer and/or internet service to finish classes in Spring 2020You have new expenses related to childcareYou are caring for sick or at-risk family membersYour classes were moved to distance deliveryYour class was unable to be moved onlineOther

I certify that the information submitted in this application is true and correct to the best of my knowledge. I further understand that any false claims may result in denial of these funds.
I agree

Please draw your signature into the box below.

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