Basic Needs Emergency Funding Request

These funds are for students experiencing a financial hardship which has caused food or housing insecurity or another basic need to not be met.

For example, if you do not qualify for CalFresh and cannot afford to purchase food, you may be experiencing food insecurity. Or, if you do not have stable housing, or are in jeopardy of losing hour housing because you cannot afford to pay your rent or a utility bill, you may be experiencing housing insecurity.

If your basic needs are not being met, you may qualify for a one-time emergency grant to help get you on track.

To qualify, students must
- have at least a 2.0 GPA
- be enrolled in 6 or more semester units
- be enrolled in a degree or certificate program
-completed FASFA or CA Dream Act Application

You must provide supporting documentation such as an official invoice, eviction notice, statement, etc.

Name Name First Last
Preferred name
Student ID Number (900...)
Are you experiencing a significant hardship that may cause you to stop or pause your educational goals

Are you experiencing a significant hardship that may cause you to stop or pause your educational goals Yes No
Have you completed FASFA or CA Dream Act Application?

Have you completed FASFA or CA Dream Act Application? Yes No Not Sure
Are you a parenting student? (a dependent under the age of 18 in your home)

Are you a parenting student? (a dependent under the age of 18 in your home) Yes No Unsure
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone - ### - ### ####
Email
Amount Requested $ Dollars . Cents
Please share whatever you are comfortable regarding your emergency need
Upload Supporting Documentation

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