FRESH Assistance Application

FRESH Assistance Application

Submitting this application does not automatically guarantee your eligibility for all services applied for. Upon completion of this form, you will receive a confirmation message indicating that we have received your application. Your application is then assigned to a designated FRESH team member who will outreach to you to schedule a 20-30 minute meeting.
Full Name

First NameLast Name
Student ID Number
Student Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Birthday

MonthDayYear
Do you have dependent children under the age of 17?
What is your enrollment status
What type of assistance are you seeking?

Other
Please describe your current situation and how we can help.
Signature
Should be Empty: