Employee Emergency Assistance Fund

Name*

First NameLast Name

Professional Title*

Department*

Mid Mich Email*

example@midmich.edu

Select the reason for your grant application.*

Emergency vehicle repair (unexpected/outside of what auto insurance covers)Home repairs that impact living conditions (water heater, furnace, burst pipes, etc.)Rent, mortgage, or utilities (to prevent eviction or shut-off)Excessive out-of-pocket medical expenses (only for employees who are not eligible for Mid’s medical, dental, and vision benefits)Other

Provide a brief summary to support the need for your request.*

Specify the dollar amount (up to $500) you are requesting.*

Attach documentation to support your request.*

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