Dean of Students

Emergency Fund Application

General Information

Gender*


Please indicate your level in school:*
What is your ethnicity?*

Select one or more races to indicate what you consider yourself to be.*




Are you an international student or a domestic student?*

Explanation

Please provide a detailed description of your emergency and the circumstances that the review committee should consider when making a decision. Please answer all of the following questions:

Are you able to provide documentation to supplement your claim (e.g. a doctor’s note, death certificate)?*

Funding Information

Description of Item
Dollar Amount