Student Affairs Emergency Grant Application



-269025-23304500Student Support ResourcesUniversal Grant/Loan/Scholarship ApplicationThe purpose of the Student Affairs Emergency Grant is to prevent students in good academic standing, who are undergoing unforeseen and unexpected financial emergencies from discontinuing their academic studies. Students with documented need and are facing a current emergency may apply for the grant. Eligibility Requirements: Students must be matriculated at the City College of New YorkUndergraduate students must have a minimum GPA of 2.00 Graduate students must have a minimum GPA of 3.00Students must have a FAFSA on file for the current academic yearStudents must have a record of good conductStudents must have paid their tuition in full for the current semesterStudents must not owe any money to the CollegeStudents must not have been awarded an emergency grant prior to applyingPlease note that your application must be complete in order to be given consideration.This application is not a guarantee that you will be awarded funds. Please print legibly.Last Name:First Name:Middle Initial:What semester are you applying for? FORMCHECKBOX Fall FORMCHECKBOX SpringYear: 20___Part 1. Determination of NeedCheck one or more of the following reasons why you are applying for the emergency grant. (You must provide supporting documentation for your emergency. See Part 5 for more information.) FORMCHECKBOX Recent and temporary loss of student’s job(s) FORMCHECKBOX Destruction of living quarters due to fire or other natural disaster FORMCHECKBOX Theft of computer, books, clothing, or other essential belongings FORMCHECKBOX Medical bills for uninsured necessary appointments, procedures, or surgeries FORMCHECKBOX Travel home for illness or death in the immediate family FORMCHECKBOX Homelessness due to loss of housing, for student and family dependents FORMCHECKBOX Other (You must give an explanation of your emergency in Part 4)Please note that funds will NOT be awarded for the following purposes:Previous debts to CCNYFull or partial tuition costs or costs related to housing in a CCNY facilityTo pay bills for cell phones, credit card, or cable/internetRent for rooms being rented/subleased in someone else’s apartment or houseRepayment of loans, mortgage, or debt owed to any banks, organizations, or personsPayment for rent or utilities that is not yet overduePayment of car insurance, car notes, or fines incurred from parking or traffic violationsLegal representation in a criminal proceeding or CCNY disciplinary proceedingYou must provide verifiable documentation supporting any extraordinary circumstances. Please be advised that if you are awarded, it may take 2-4 weeks to process your check. This is a one-time, short-term assistance. Previous award recipients are not eligible to apply for another emergency grant. The maximum award amount is $1,500.Amount Requested*: _________________*Do NOT leave this field blank. This amount must match the total requested in your statement of need (Part 4) and you must provide a breakdown of this amount in your itemized budget. Part 2. Personal InformationDate of Birth:Social Security Number:Mailing Address:Apartment #City:State:Zip Code:Cell Phone Number:Home Phone Number:CCNY Email Address:*Alternate Email Address:*All emails and communication concerning your emergency grant application will be sent to your CCNY email address. Student Affairs will not be held responsible if you do not regularly check your CCNY email.Sex: FORMCHECKBOX Male FORMCHECKBOX FemaleHave you paid your tuition in full for the current semester? FORMCHECKBOX Yes FORMCHECKBOX No(Attach a copy of your current semester tuition bill showing a zero balance. Students who owe money to the college are not eligible for an emergency grant.) Did you file a FAFSA for the current academic year? FORMCHECKBOX Yes FORMCHECKBOX No(Students who are eligible to file a FAFSA must have a current one filed at )Are you receiving financial aid for the current semester? FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, list here: ____________________________________________________________Are you receiving any other Scholarships or Grant Money? FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, list here: ____________________________________________________________Are you a U.S. Citizen? FORMCHECKBOX Yes FORMCHECKBOX NoAre you a Legal Permanent Resident? FORMCHECKBOX Yes FORMCHECKBOX NoAre you an F1 Student? FORMCHECKBOX Yes FORMCHECKBOX No(If so, please provide a letter of support from your International Student Advisor)Other immigration status (explain): ______________________________________________Are you a member of a fraternity or sorority? FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, explain: ______________________________________________________________Are you a student veteran? FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, explain: ______________________________________________________________Are you a member of any athletic team? FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, explain: ______________________________________________________________If you answered yes to questions #9, 10 or 11, please provide the name and contact information of the fraternity/sorority, Veterans Affairs coordinator, or Athletic Department director on campus, whom we may contact on your behalf.Contact InformationName: Email:Telephone Number:Part 3. Academic InformationAttach a copy of your unofficial transcript and current semester class schedule (print from e-sims)Undergraduate Students:What year are you in? FORMCHECKBOX Freshman FORMCHECKBOX Sophomore FORMCHECKBOX Junior FORMCHECKBOX Senior Current cumulative GPA: __________Total undergraduate credits as of current semester: ________ Major: __________________________________Expected date of graduation: ___________Graduate Students:What is your graduate program & degree in progress? ______________________________________Where did you complete your undergraduate work? ________________________________________Incoming Graduate Students: What was your cumulative undergraduate GPA? __________Continuing Graduate Students: What is your current GPA? _____________Expected date of graduation: _________________Part 4. Statement of Need*Your application is incomplete and will not be considered unless you have provided both a statement of need and all supporting document(s). Please refer to the documents checklist at the end of the application.Statement of Need:Attach a typed, one-page statement explaining your emergency and describing how the funds will be used. Please be as detailed as possible. Answer ALL of the following questions in your statement of need:Briefly explain the nature of your emergency and how the grant you are requesting will be used.How would this grant assist you in remaining in school?How were you supporting yourself prior to your emergency? Why are you unable to do so now?The emergency grant is a one-time, short-term assistance. If awarded, you will not be eligible to apply for another emergency grant. How do you plan on supporting yourself in the future? What efforts have you made to procure financing from other sources? Have you been successful? Why or why not?Itemized Budget:Include an itemized budget that provides a breakdown of your intended expenses (what you will use the money for), if awarded. Your budget should include the total amount you are requesting and this amount should match the requested amount in Part 1. You must provide documentation for each itemized cost (see Part 5). See example below.Metrocard$104Food$100Total$204Part 5. Supporting DocumentationYou must submit supporting documentation for your emergency situation AND documentation that supports your requested expenses in your itemized budget. Provide 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.If your documents do not meet the following requirements, they will not be included in your application. ALL documentation MUST be:Current and up-to-date (we do not accept any documents more than 3 months prior to your request)Addressed to you or are in your name (all bills and statements must be in the name of the student applying for the emergency grant)Typed and dated (no handwritten notes)All letters must be on professional business letterheadDocumentation Supporting Your Emergency Situation from Statement of NeedBased on your statement of need, please submit documentation that verifies your emergency situation. See the following emergency situations for the appropriate documentation to submit. Required documents will differ on an individual basis.For recent and temporary loss of student job: submit a letter from your employer or NYS Department of Labor, as well as your unemployment status or statement of benefits. Or if your hours have been reduced, submit your last 3 paystubs showing the decrease.Destruction of living quarters due to fire or natural disaster: a letter or statement from the Red Cross, FEMA, or other emergency organization. Also include any related insurance information regarding coverage of the damage or lack thereof.Theft of computer, books, and essential belongings: Include the police report or CCNY public safety report.Medical bills from uninsured dental or medical procedures: Include all invoices from the doctor’s office or hospital, a note from your doctor verifying that this procedure is necessary for you, a letter from your insurance company denying you coverage, and a police report (if applicable)Travel home for illness or death in the immediate family: include a letter from family doctor or funeral parlor, airline informationHomelessness due to loss of housing: eviction notice and rent statement showing overdue rent, letter from shelter verifying your stay Documentation Supporting Your Requested Expenses from Itemized BudgetFor each requested expense listed in your statement of need, you must submit a supporting document. Acceptable documentation includes receipts, rent statements, medical invoices, utility bills, etc. Rent statements must show that rent is overdue and in arrears in order to qualify for emergency assistance.Utilities bills must show an overdue balance and/or include a shut-off noticeFor proposed purchase of necessary or replacement items, submit a print out of the specific item description and priceSubmitting your documentation: We accept copies of documents. You can fax documents to 212-650-7080 or scan and email them to studentaffairs@ccny.cuny.edu. Please call the office to confirm PLETION OF THIS APPLICATION DOES NOT GUARANTEE THAT YOU WILL BE AWARDED FUNDS.ALL ABOVE ELIGIBILITY CRITERIA MUST BE MET FOR YOU TO QUALIFY TO RECEIVE AN EMERGENCY GRANT.DISCLAIMERIf it is determined by Student Support Resources that there is a dual/ pre-existing relationship with Student Affairs/ Student Support Resources (e.g. students who have worked for the Counseling Center/ Student Health Services, those with the unusual circumstance of having applied for emergency grant/ loans in the past, or any other pre-existing relationship); in keeping with confidentiality/privacy privileges, I agree to have my application reviewed and processed by an alternate office._____________________________________________________________________Student SignatureDateQuestions? Contact the Office of Student Affairs by calling (212) 650-5426 or emailing studentaffairs@ccny.cuny.edu ................
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