Name* Phone Number*
First Name Middle Last Area Code Phone Number
Current Mailing Address*
Street Address City State Zip Code
The fastest way to receive your grant if you are awarded one is to ensure your mailing address is accurate. Please provide your current physical address.
Last 4 digits* of SSN: XX-XX- or Last 4 digits* of Student ID Number: -0XXX
COVID-19 Emergency Grant Eligibility Requirements:
• Any currently enrolled student at Montana State University Northern
o Excludes: students enrolled in an exclusively on-line program and non-citizen students.
• Students must be eligible for Title IV funds (Federal Financial Aid)
• Students must have unexpected expenses resulting from the disruption of campus operations due to the
COVID-19 Emergency Grant Guidelines:
• Grant funding will vary, as funding will be specific to individual student needs
What this grant does NOT Cover:
• Legal Fines/Expenses
• Parking Tickets/Fines
• Costs of entertainment, recreation, or non-emergency travel
• Tuition and fees outstanding to the college
• Lost wages, as this is not considered an expense
Which of the following emergency or unforeseen circumstances are you currently facing?
Technology and connectivity needs related to distance learning
Housing/Rent expenses related to the disruption of campus operations (i.e.: deposit or rent on apartment after
campus closure, utility bills, etc.)
Other emergency or unforeseen expenses*
I am requesting Montana State University Northern to consider my circumstances to determine if I may be eligible for a COVID-19
Emergency Grant according to the Department of Education Federal Regulations. I agree to provide any documentation requested if
it can be obtained. I understand that any decisions are final.
Student’s Initials*: Date*:
Please submit this form electronically and any required/requested documentation by the priority deadline
5:00 pm on May 15, 2020. Applications received after this date will be processed as we receive them.
RETURN DOCUMENTATION TO: FINANCIAL AID OFFICE Montana State University Northern
email@example.com or fax to: 406-265-3519.
MSUN Northern does not discriminate on the basis of race, color, national origin, age, sex, or disability.