Emergency Financial Aid Grant (CARES-Act) Form

Emergency Financial Aid Grant (CARES-Act) Form

The U.S. Department of Education has made available an Emergency Financial Aid Grant that University of the Potomac can distribute to students that are eligible to receive federal student aid, and who need financial support for their expenses related to the disruption of campus operations due to the COVID-19 pandemic (on or after March 13, 2020). Expenses include course materials, technology, housing, and utilities. This request form allows students to request these need-based grants. Our CARES Act Committee will use the information you provide below to determine the amount you will receive. Once the completed form has been received, we will begin the reviewing process. If you are awarded the grant, we will mail a check to you. Please fill out the information requested below on this form and submit it to us. Remember to provide your current mailing address, email, and phone number. We will use this information to update our records and to mail the grant funds to you.
Current Campus*
Student Services Email
Name*

First NameMiddle NameLast Name
Student ID*
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Check all expenses that you have incurred:*

Course MaterialUtilitiesHousingTechnology (laptop/ hotspot)HealthcareOther
Please provide details:
Please describe how the COVID-19 pandemic has affected you.*
I attest that all information is true and accurate, and I am requesting a one-time Emergency Financial Aid Grant to help cover the costs of expenses incurred due to the COVID-19 pandemic. I understand that I will be unable to revise this request after submitting it, and I understand that the administration at my school will determine my eligibility for grant monies based on my responses to the questions above.
Document attached.*

YesNo
File Upload*

Cancelof
Student Signature*

Clear
Date:*

MonthDayYear
Office Use Only
Approved: Yes [ ] No [ ]. Reason:________________________________________

Committee Representative:______________________________________________
Should be Empty: