Student Name:
*
First Name
Last Name
NSHE ID (Student ID Number)
*
Email:
*
example@mail.tmcc.edu
Phone Number:
Please enter a valid phone number.
Format: 000-000-0000.
TMCC Counselor Reference:
*
First Name
Last Name
Student Status:
*
Full-time Student
Part-time Student
Employment Status:
*
Work Full-time
Work Part-time
Unemployed
Foster Youth:
*
Yes
No
Is student currently enrolled in 3 credits or more at TMCC?
*
Yes
No
Does student have a 2.0 GPA or higher, cumulative?
*
Yes
No
Semester of Emergency and Request (must be the same):
*
Spring
Summer
Fall
Why is the student requesting funding from the Emergency Resource Fund?
*
Please include the following: the emergency event that has occurred, how this event is impacting their ability to be successful in school, how they will then become more stable or self-sufficient as a result of receiving the funds.
What is the student's degree path and/or career objectives?
*
Has the student enrolled in the Supplemental Nutrition Assistance Program (SNAP)?
*
Yes
No
Explain why the student has not enrolled in SNAP?
Has the student applied for the Educational Partnerships Program (EPP)?
*
Yes
No
Explain why the student has not applied for EPP?
Total Amount Funds Requested:
*
Documentation Upload:
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Please attach any documentation, such as invoices, rental agreements, bills, quotes for repair, etc. (combine into a single file).
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Sender Name:
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