5/05/2020
COVID-19 Emergency Grant Application
Students affected by the coronavirus pandemic may be eligible to receive funds that were allocated to Edison State
Community College as a part of THE CORONAVIRUS AID, RELIEF, AND ECONOMIC SECURITY (CARES) ACT. The
CARES Act provides institutions with funds to make emergency financial aid grants to students to help cover expenses
related to the disruption of campus operations due to coronavirus. Check and complete any expenses that apply to your
situation and provide a brief description as indicated. The maximum award amount is $6000. Be prepared to provide
supporting documentation if necessary.
The Process:
All requests will be considered on a case-by-case basis and each student’s individual circumstances. Review of
applications will begin immediately. Notice of any funds awarded will be sent via Edison State Community College email.
Additional guidance is expected from the U.S. Department of Education and may affect the awarding of grant funds.
Instructions for submission:
1. Complete this form electronically
2. Save to your own laptop or device
3. Email the saved file to jchambers2@edisonohio.edu as an attachment for review.
Last Name
First Name
Student ID#
Phone Number
Date of Birth
Housing/Food Related Expenses
Cost Associated: $
Please provide a brief description that explains how this cost is associated with the disruption of campus operations:
Course Materials/Supplies Related Expenses
Cost Associated: $
Brief description that explains how this cost is associated with the disruption of campus operations:
Expenses related to required technology for remote learning
Cost Associated: $
(May include new or additional computer or laptop, headset with microphone, webcam, internet or increased internet capability, etc.)
Brief description that explains how this cost is associated with the disruption of campus operations:
Child Care Expenses
Cost Associated: $
Brief description that explains how this cost is associated with the disruption of campus operations:
(Continued on page two)
5/05/2020
Other Expenses
Cost Associated: $
Brief description that explains how this cost is associated with the disruption of campus operations:
Total amount of Emergency COVID-19 Grant for which you are applying: $
My signature on this form attests that I agree to use the emergency funding for the purposes stated above.
Student’s Signature
Date
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