Student Emergency Fund Application
Name
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First Name
Last Name
Richmont Email Address
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Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Are you currently enrolled in a class this (current) semester at Richmont Graduate University? (A currently enrolled student is actively taking a fall, spring, or summer semester course in the current semester.)
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Yes
No
List your current semester classes and professors.
Do you currently receive Financial Aid to attend Richmont?
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Yes
No
Have you previously applied for funds from the Student Emergency Fund?
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No
Yes
If yes, what semester did you apply?
Was your request from the Student Emergency Fund approved?
Yes
No
If yes, what amount were you awarded?
If you are asking for an exception and would like to request funds from the Student Emergency Fund a second time, please describe here your current situation and why it is an unforseen, serious or exceptional nature, beyond typical emergencies.
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Amount you are requesting from the Student Emergency Fund ($1,000 max.)
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Briefly explain your situation and describe the resulting temporary financial hardship resulting from a sudden emergency, accident, or unforeseen event. Please describe why your capability to attend Richmont Graduate University must be in jeopardy due to the emergency.
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Supporting Documentation
Please upload supporting documentation to accompany your application. Supporting documentation should display the amount of funds needed to cover your unexpected expense. Your documentation needs to show that you owe (or have paid) amounts equal to or above the amount you are requesting. For example, a bill, invoice, receipt would be supporting documentation. Please do not include supporting documentation that includes receipts for the following: Tuition, student fees, health insurance, Non-essential utilities, (i.e. cable, Internet, phone), Application or test fees, Household costs not related to damage or theft, Costs for entertainment, recreation, non-emergency travel or other non-essential expenses, Expenditures occurred as a result of poor financial management and not an emergency, or Medical expenses needed for a family member or friend of the student requesting services.
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Please Sign Below
By signing below, I sign that all information included in this application is correct. I understand that the Student Emergency Fund Committee will review and consult with the Business and Financial Aid Offices as needed, in order to accurately review my application.
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