CARES II Hardship Fund Grant Application

Section 1: Student Personal Data

Last Name *

First Name *

Middle *

SRC Student ID #: *

Date of Birth: * +

Maiden Name (if applicable):

Street Address *

City, State, Zip *

Email Address *

SRC Email Address *

Total SRC Credits Completed: *

Credit Hours This Semester: *

Program of Study *

Campus Attending *

I am classified as a... *

Freshman (0-29 hours)

Sophomore (30+ hours)

I received a SRC scholarship in the previous year *

Yes

No

I have submitted the FAFSA *

Yes

No

Degree/Certificate Sought: *

Section 2: Application Questions

1) Amount Requested: *

2) Please describe your need for funds and how the amount requested will help meet this need. *

3) How will funding help you be successful in your SRC courses this semester? *

4) How does your need interfere with your ability to attend SRC and/or complete your coursework? *

5) What efforts have you made to obtain funding from other sources and have you been successful? *

6) Please include/attach copies of any and all supporting documentation that provides evidence of your situation and justifies your request. Examples include, but are not limited to: expenses related to the disruption of campus operations due to COVID-19, such as food, housing course materials, technology, computer expense, health care and childcare expenses; or anything that you believe justifies your request or provides evidence of your needs.

Attach Documentation 1

Attach Documentation 2

Attach Documentation 3

Attach Documentation 4

Attach Documentation 5

Affirmation *

I have read and understand all criteria and requirements regarding Spoon River College CARES Hardship Fund Grant and I certify that all information I have supplied on this application is correct. I understand that applying does not guarantee approval, and that submitting an application does not obligate the SRC to award me with a financial grant. I hereby authorize the appropriate individuals to review my student records and disseminate information to the CHFG Committee by e-mail as necessary. I understand that the information I have submitted will be handled privately and will not be shared beyond those with a distinct need to review my application (including, but not limited to: the Dean of Student Services, the Director of Business Services, the Director of Financial Aid.) I also understand that those individuals may contact me for further information. I understand that checking this box signifies agreement with the policies outlined in this application. I also understand that, while SRC goes to great lengths to ensure that my information is secure, electronic submission of this information is at the sole risk of the applicant if I choose to submit electronically.

Type your name below, which will serve as your electronic signature *

Ready to submit?

Yep!

This is the end of the student application. The rest of the sections are for office use only.

Section 3: Financial Aid (Office Use Only)

Financial Aid Comments:

Approve or Deny?

Approve

Deny

Ready to submit?

Yep!

Section 4: Business Office (Office Use Only)

Business Office Comments:

Approve or Deny?

Approve

Deny

Ready to submit?

Yep!

Section 5: Dean of Student Services (Office Use Only)

Dean of Student Services Comments:

Approve or Deny?

Approve

Deny

Ready to submit?

Yep!