Graduate Student Worker Emergency Relief Fund

Application for
Graduate Student Worker
Emergency Relief Fund

This form may only be completed by the Graduate Student Workers who are covered by the collective bargaining agreement between Fordham and CWA Local 1104.

Prior to filling out this form, please review the Examples of Eligible and Ineligible Expenses (add link to page) page. The maximum award for eligible requests is $300.

Personal Information

Fordham ID #*

Please begin your ID # with the letter A

Full Name*

First NameLast Name

Fordham E-mail Address*

myname@fordham.edu

Phone Number

Area CodePhone Number

Academic Information

Degree Sought*

Department/ Program*

Emergency Relief Fund Information

Have you received Emergency Relief funds in the past?*

YesNo

If yes, what date did you receive the funds?

Have you received emergency funding from your department/program or any other office at Fordham (SEAT, STEEL, etc.)?*

YesNo

If yes, please indicate source and amount of funding.

Have you been in contact with any Fordham offices, (Human Resources, Graduate School of Arts and Sciences, Student Affairs, Office of International Services, etc.)?*

YesNo

If yes, with which office(s) were you in contact?

What is the amount of money requested from the emergency relief fund?*

Please upload a brief (1-2 paragraph) description of the emergency. If requesting funds to cover multiple expenses, please include an itemized budget.

Browse Files

Upload description of the emergency

By printing my name below, I am certifying that all information provided is correct and that I am submitting the application for emergency relief funding.

Signature*

(please type full name)

Date Submitted*

MonthDayYear