Student Emergency Grant Application

Student Emergency Grant Application

The Emergency Grant Program seeks to assist eligible students coping with unexpected hardships. The Law School seeks to assist students to complete their education, rather than take a leave of absence or withdraw from school. Please review this application in depth and be prepared to submit supporting documentation.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
CUNY ID #*
This number is found on our law school ID card or on CUNYFirst.
Phone Number*

Area CodePhone Number
Email*
example@example.com
Class Year*

1L2L3L4L
Program*

Day/Full TimeEvening/ Part Time
Do you have children?*

YesNo
If, yes, how many children?*
Please submit supporting documentation in the supporting documents section.
Do you have any other dependents, i.e. elderly parents?*

YesNo
If, yes, how many additional dependents (NOT children). *
Please submit supporting documentation in the supporting documents section.
Amount Requested (up to $1,500):*
Statement of Need
Please select all that apply the type of Emergency/Need you are requesting funding for with documentation?*

Basic EssentialsBooksChild CareEmergency DentalEmergency TravelFoodHousing/RentIncome Loss/UnemploymentEmergency MedicalPrinting (You must submit a receipt for Printing Reimbursement)Theft of BelongingsTravelUtilitiesWifiOther
Please briefly explain the nature of your emergency and how the grant you are requesting will be used. If you require additional space, you may attach a statement below. *
Additional Statement (Optional)

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Do you have documentation of the above emergency(e.g. police report, medical bill, court dispossession notice, etc.)?

YesNo
Applicants are required to submit relevant documentation in order to validate any costs or circumstances claimed in the application, and applications that cannot be verified will be denied.

If you have questions about supporting documentation, please email emergency.grants@law.cuny.edu.

Examples of documentation include, but are not limited to, the following:
- Police Report
- Medical Bills and Proof of Insurance Denial
- Court Dispossession Notice
- Lease Agreement, or Roommate Agreement
- Separation Agreement
- Receipts
- Bank or Credit Card Statements
- Monthly budget of expenses
- Printing Receipt (Must be included with request for printing reimbursement)
*Please note: If you are providing financial support to someone else as part of your emergency, you must provide proof that you have claimed that person as a dependent on your IRS Tax Form.
Submit all of your supporting documentation of the above emergency or reimbursement here. *

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Emergency Grant Reimbursement for Printing Materials

If you need to print, student printers/copiers are available on the first floor of the building and you should make an appointment to access the building. If you need to print as a result of an accommodation from Student Disability Services, other funds are available, and you should contact Pat Kennedy at kennedy@law.cuny.edu. If you are unable to access the building, Emergency Grant funds are available to reimburse students for the cost of printing materials. The maximum reimbursement for printing materials is $100.00 per semester.

To qualify for print reimbursement, please confirm the following:
- I was unable to access the building to use one of the student printers/copiers on the first floor.
- The printing was not the result of an accommodation requirement from Student Disability Services.
Do you confirm the above in regard to printing reimbursement?*

YesNo
Do you have insurance (medical, auto, etc.) that would cover all or part of these expenses?*

YesNo
What efforts have you made to procure financing from other sources? *
Have you requested emergency funding in the past through the emergency grant or loan program?*

YesNo
If this is not your first-time requesting emergency funding, please indicate when and what other funds you have requested and received.
I certify that the information provided on this application is true. (Sign below.)

Clear
Please verify that you are human*
Should be Empty:

Student Emergency Grant Application

Statement of Need