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[pic] REQUEST FOR EMERGENCY ASSISTANCE FUNDING

The University of Cincinnati is willing to consider providing tuition and other support to international students who have experienced a severe and unforeseen economic hardship as a result of emergent circumstances in the home country that are beyond the control of the student or their sponsors. Emergent circumstances can include a severe devaluation of the home country’s currency, natural disasters such as earthquakes, hurricanes, or Tsunami’s, civil unrest, or other special circumstances deemed legitimate by UC. Circumstances that will not be considered for funding will include loss of a graduate assistantship, loss of a job by a parent or sponsor, unexpected bills or expenses, and other related expenses. Students must make every effort to obtain support from family, friends, and other sources before making this request.

Students who wish to apply for such funding must document to UC International Services the “severe” and “unforeseen” economic hardship. If the circumstances are deemed to be severe and unforeseen, UC International Services will present a request for funding to a special committee that will make the determination as to funding amount, purpose and duration. Students must make every effort to obtain support from family, friends, and other sources before making this request. Graduate students must discuss the situation with their graduate program and be able to document what assistance, if any, the graduate program can provide.

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_____________________________________ _____________________________________

Name of Student Email Address

_____________________________________ _____________________________________

Program of Study UC ID Number

_____________________ ____________________

Date Started at U.C. Degree being pursued

_____________________ ____________________

Expected graduation date Current GPA

Amount of funding needed for living expenses per semester: $__________________________

Amount of funding needed for tuition and fees per semester: $__________________________

Please indicate if the funding needed is: _____ For one semester only _____ Until Graduation

Please provide the name, email address and phone number for your departmental (if graduate student) or college (if undergraduate student) advisor:

___________________________________ __________________________ ____________

Name of advisor Email of advisor Phone #

If you currently have outstanding fees owed to the University of Cincinnati, please indicate the amount owed: $__________________. Cell Phone #: _____________________________

-Over-

Reason(s) for requesting Economic Hardship funding:

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

Checklist of Supporting Documents

All requests for the emergency fund must include: (1) Completed Request for Emergency Assistance Funding Request Form; (2) Documentation of the change in your financial situation. All reasons must be verified with supporting documentation. For example, if your sponsors have lost the ability to fund you, a letter must be supplied by the sponsor describing what funding has been lost and why, in addition to supporting documentation that verifies that loss of funding. (supporting documentation will vary based on the circumstances); (3) Letter from your Academic Advisor detailing your academic standing in your program, a timeline for graduation, and support of your request; (4) A breakdown of your monthly living expenses including rent, meals, utilities, and other expenses; (5) A printout of your transcript from Catalyst; (6) A printout of your current billing statement from Catalyst.

I certify that the information and documentation submitted is correct and complete.

Student's Signature ___________________________________Date_______________

All required documents should be submitted to:

Ron Cushing, Director

UC International Services

3134 Edwards Center One

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