Klamath Community College Foundation
Education Access & Opportunity Fund
Grant Application
1
Please return this form to:
Klamath Community College Foundation
Attn: Patricia Springer (or via email to springer@klamathcc.edu
)
7390 South Sixth Street
Klamath Falls, OR 97603
*Students who received CARES Act funds in 2020 are not eligible for this award*
1. Date:
2. Name:
3. Address:
4. City: State Zip Code
5. Phone:
6. Email:
7. Student Identification Number:
8. I am not eligible for Title IV Financial Aid (FAFSA). True _______ False ______
9. I am currently enrolled at KCC. Summer _____ Fall _____
10. Funding request $__________ (There is a $500 cap per request and funds are limited. The review committee
may approve an amount less than your request)
11. Please describe your need for this emergency financial support:
(Add additional pages if needed)
12. If applicable, please attach a quote, invoice, receipt, or advertisement substantiating your request.
This program is open until September 30, 2020 (and can be extended at the sole discretion of the KCC
Foundation Board)
I certify that all information I have provided on this form is true to the best of my knowledge.
Signature
Name (Please Print)
Date
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signature
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