AAU Member Emergency & Assistance Program (MEAP)
Name
*
First Name
Last Name
Campus:
*
Member ID (W number):
*
Please indicate:
*
Faculty
Professional Support
Please tell us why you are requesting assistance:
*
Information shared with the Union is considered confidential
Additional Information
Do you have insurance for this kind of event?
*
Yes
No
If you answered yes above, who is your insurance provider?
*
Are you receiving any other financial assistance?
Yes
No
How much financial assistance are you requesting?
Please provide us with the best way to contact you:
I hearby confirm the information provided in the MEAP application is truthful and correct
Signature
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Continue
Continue
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