Student Emergency Fund

Contact Information Full Name Student ID# Email Address Cell Phone Number

Academic Information

Are you currently enrolled at EMU? Yes No

Are you currently receiving financial aid? Yes No

Current Year in School Major

Local Address Local Address Local City Local State Local Zip / Postal Code

Permanent Address Permanent Country Permanent Address Permanent City Permanent State Permanent Zip / Postal Code

Eligibility Requirements Please indicate the purpose of the funds (i.e. food, medical bills, etc) Amount of funds requested ($750 Maximum) Please explain why these funds are needed. How will the funds be used, if granted? How may these unexpected expenses affect your ability to remain enrolled at EMU? Please explain your efforts to look into other resources for assistance with these unexpected expenses (i.e. family, community, campus resources)

Supporting Documents

Attach Document

Signature Signature By signing this form I realize information about my situation will be shared with the review committee.

Submit to review committee