“CARES Act”
COVID-19 Emergency Student Financial Aid Grant Application
An Equal Opportunity Educational Institution Serving the Community without regard
to Race, Creed, Sex, National Origin, or Disability
Student ID#: _____________
First Name: ___________________ Middle Initial: _____ Last Name: ______________________
Address: _____________________________________________________________
City: _______________________________ State: _______ Zip: _________________
Telephone: ______________________ Email: _________________________________________
Requested Amount: ____________________
I certify that I, ___________________________, have expenses that relate to the disruption of
campus operations due to COVID-19 and that I was not enrolled exclusively in online programs.
Student Signature: _______________________________________ Date: __________________