CARES Act Confirmation Form

In response to the coronavirus pandemic, funds have been made available through the CRRSAA Act to award emergency grants to students for expenses related to the any component of the student’s cost of attendance or for emergency costs that arise due to coronavirus. Eligible expenses include tuition, food, housing, health care (including mental health care), or childcare. The Campus has deemed you eligible to receive an emergency grant. This is not a loan and will not need to be paid back and will not affect your financial aid award amounts for academic year 2021-2022.

Students have the option to use their HEERF II Grant funds to pay any current balance due at the College or to receive the full amount of the Grant in a check.

Any amount of the Grant remaining after paying the balance due, as noted below per the student's response, will be issued as a check.

Student Name*

First NameMiddle NameLast Name

Date of Birth*

Date

Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email address*

Phone Number*

Area CodePhone Number

Do you accept the HEERF II Grant?*

If you are declining the grant please answer "I do not agree" for the next two statements

I certify that I have or will incur allowable expenses of food, housing, course materials, technology, health care, childcare, and/or transportation as a result of the disruption of campus operations due to coronavirus which equal or exceed the amount of the this CARES Act grant award.*

I have read the intended use for funds, and I agree to use the funds appropriately.I do not agree.

I understand it is my responsibility to notify the Financial Aid office immediately if I will not incur expenses that meet or exceed the amount of my award.*

I agree.I do not agree.

Do you want your HEERF II Grant to first pay any current balance due on your account?*

How much of your HEERF II Grant do you want to use towards your current balance?*

AllNone, receive the full Grant in a checkOther

Please verify that you are human*

Signature*

HEERF II Student Aid Confirmation Form