Cabarrus College of Health Sciences
COVID-19 Federal CARES Act Emergency Grant
Application
In conjunction with the United States Department of Education, the College would like to notify you that
you may be eligible to receive grant funds as a result of the CARES Act. Eligibility will be reviewed on an
individual basis with the completion of this application.
To qualify for the Federal Emergency funds, the student must have been enrolled at Cabarrus College
of Health Sciences during the Spring 2020 semester
Name: ID:
Student’s Name (Last, First, M.I.) Student Identification Number
Email Address: Phone Number: Program of Study
Complete all the items below
1. The number of currently working adults in your home __________________
2. The number of dependents in your home ___________________
3. How has COVID 19 impacted you? Please explain below and include related expenses in the box
below.
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Type of
Expense
Dollar Amount Requested
Transportation
Housing
Living Expenses
Books and Supplies/technology (computer and internet)
Other
By signing this form, I certify that the above information is complete and accurate, and I agree to provide
receipts and/or other documents if requested in support of this application. I also understand that
submission of this application does not guarantee that additional assistance will be awarded, and the
amount awarded could vary by student.
Completed application must be submitted by May 8, 2020 to be considered.
Student Signature: Date:
Submit
Submit
Submit
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