Student Affairs Emergency Grant Application

Student Support Resources

Universal Grant/Loan/Scholarship Application

The 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 York

·  Undergraduate students must have a minimum GPA of 2.00

·  Graduate students must have a minimum GPA of 3.00

·  Students must have a FAFSA on file for the current academic year

·  Students must have a record of good conduct

·  Students must have paid their tuition in full for the current semester

·  Students must not owe any money to the College

·  Students must not have been awarded an emergency grant prior to applying

Please 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.

What semester are you applying for? Fall Spring Year: 20___

Part 1. Determination of Need

Check 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.)

Recent and temporary loss of student’s job(s)

Destruction of living quarters due to fire or other natural disaster

Theft of computer, books, clothing, or other essential belongings

Medical bills for uninsured necessary appointments, procedures, or surgeries

Travel home for illness or death in the immediate family

Homelessness due to loss of housing, for student and family dependents

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 CCNY

·  Full or partial tuition costs or costs related to housing in a CCNY facility

·  To pay bills for cell phones, credit card, or cable/internet

·  Rent for rooms being rented/subleased in someone else’s apartment or house

·  Repayment of loans, mortgage, or debt owed to any banks, organizations, or persons

·  Payment for rent or utilities that is not yet overdue

·  Payment of car insurance, car notes, or fines incurred from parking or traffic violations

·  Legal representation in a criminal proceeding or CCNY disciplinary proceeding

You 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 Information

*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.

1.  Sex: Male Female

2.  Have you paid your tuition in full for the current semester? Yes 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.)

3.  Did you file a FAFSA for the current academic year? Yes No

(Students who are eligible to file a FAFSA must have a current one filed at http://www.fafsa.ed.gov/)

4.  Are you receiving financial aid for the current semester? Yes No

If yes, list here: ______

5.  Are you receiving any other Scholarships or Grant Money? Yes No

If yes, list here: ______

6.  Are you a U.S. Citizen? Yes No

7.  Are you a Legal Permanent Resident? Yes No

8.  Are you an F1 Student? Yes No

(If so, please provide a letter of support from your International Student Advisor)

Other immigration status (explain): ______

9.  Are you a member of a fraternity or sorority? Yes No

If yes, explain: ______

10.  Are you a student veteran? Yes No

If yes, explain: ______

11.  Are you a member of any athletic team? Yes No

If 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 Information

Part 3. Academic Information

Attach a copy of your unofficial transcript and current semester class schedule (print from e-sims)

Undergraduate Students:

What year are you in? Freshman Sophomore Junior 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:

1.  Briefly explain the nature of your emergency and how the grant you are requesting will be used.

2.  How would this grant assist you in remaining in school?

3.  How were you supporting yourself prior to your emergency? Why are you unable to do so now?

4.  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?

5.  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 $104

Food $100

Total $204

Part 5. Supporting Documentation

You 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 letterhead

Documentation Supporting Your Emergency Situation from Statement of Need

Based 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 information

·  Homelessness 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 Budget

For 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 notice

·  For proposed purchase of necessary or replacement items, submit a print out of the specific item description and price

Submitting your documentation: We accept copies of documents. You can fax documents to 212-650-7080 or scan and email them to . Please call the office to confirm receipt.

______

Student Signature Date

Questions? Contact the Office of Student Affairs by calling (212) 650-5426 or emailing

Updated 1/30/2013 5