FRC Emergency Funding Request

This request form is for students experiencing an unexpected emergency that may impact their ability to continue their educational pursuits

To qualify students must meet the following critera:
-have at least a 2.0 GPA and be in good academic standing (some exemptions may apply)
-be enrolled in 6 or more semester units
-be enrolled in a degree or certificate program
-completed a FAFSA, CA Dream Act Application, or be an international student

Be sure to upload supporting documentation of your emergency with your name on it. Examples include but are not limited to: utility bill, eviction notice, new lease agreement, medical bill, 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 FAFSA or CA Dream Act Application?

Have you completed FAFSA or CA Dream Act Application? Yes No Unsure
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
Email
Amount Requested $ Dollars . Cents
Please share whatever you are comfortable regarding your emergency need
Upload Supporting Documentation
Draw your signature into the box below to confirm the information provided in this application is true and accurate

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Full Name

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