Calhoun Student Emergency Grant (SEG) Fund Application

Calhoun Community College Student Emergency Grant (SEG) Fund Application

The Student Emergency Grant (SEG) Fund has been awarded to Calhoun Community College for the purpose of providing quick-response emergency grants to matriculated students in good academic standing who are facing a short-term financial emergency. The goal of the Calhoun Student Emergency Grant Fund is to help students remain in school. Upon submission, you will receive confirmation that your application has been received.
Part I: Contact Information
Student's Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Calhoun Student ID*
Enter numbers after A
E-mail*
include @
Phone Number*

Area CodePhone Number
Part II: Determination of Need
Grant amount requested*
must attach documentation below to verify amount requested
Check one or more of the following reasons why you are applying for the emergency grant? Emergencies that qualify for a SEG include:*

Temporary loss of job or incomeHomelessness or sudden loss of housingFire in living quartersTheft of computer, books, clothing or other essential belongingsMedical/Dental emergenciesFood or transportation needsTravel expenses due to illness/death in immediate familyOverdue utility bills/turn-off noticeTransportation cardLoss of childcareVictims of Domestic ViolenceOther
Please Note: Student Emergency Grant aid will NOT be awarded:
- To cover previous college debt
- To pay for full or patial tuition or college fees
- To pay for legal representation in a criminal proceeding
Part III: Academic Information
What year are you in?*

FreshmanSophomore
What is your Major?*
Total Credits earned:*
Current Overall GPA:*
Did you file a FASFA for the current academic year?*

YesNo
Part IV: Supplementary Documentation
Statement of Need: Write a brief statement explaining your emergency and describing how the funds will be used. Please itemize each cost and provide a total of requested amount.*
Statement of Need
Supporting Documentation: In the area below, please upload files providing as much evidentiary documentation as possible in order to support your reason for requesting an emergency grant. The more documentation you are able to supply, the better your chances for being awarded a grant.

Examples of acceptable documents include medical bills, bank statements, letter from employer stating your loss of job, letter from your property owner stating rent owed or loss of housing, police report for theft, etc.
Upload File(s) Here:*

Supporting Documents
ex. bills, letters, police report, etc. Cancelof
Part V: Additional Services

Calhoun Community College offers additional free services and we would love to assist you. Please answer questions below so we may refer you.
Are you a parent of a child age 18 years old or younger?*

YesNo
If you answered Yes to the question above, list the number of children under age 18.
Are you in need of food, hygiene or household supplies?*

YesNo
Would you like to receive counseling?*

Yes, please refer me.No, I do not wish to be referred at this time.
Student Signature*

Clear
Date*

MonthDayYear
Date
Note:
1. A student application must be completed in order to be given consideration.
2. A student is not guaranteed any awards based on submitting an application.
3. Student may only receive a grant once per calendar year.
Should be Empty:

Calhoun Community College Student Emergency Grant (SEG) Fund Application

Part I: Contact Information

Part II: Determination of Need

Part III: Academic Information

Part IV: Supplementary Documentation

Part V: Additional Services