Rev. 12/13/2017
Ekho Your Heart
APPLICATION
The CSUCI Ekho Your Heart Program is a special fund that was established within the CSUCI Foundation, and is designed to pro-
vide assistance to employees experiencing a temporary hardship. The program may help with food and/or other necessities
for CSUCI employees. Awards are granted on a case-by-case basis.
APPLICATION PROCESS
1. Complete the Application Form with appropriate explanation and supporting documentation.
2. Print, sign and deliver to Human Resources, Lindero Hall, Room 1804.
OR Print, sign, scan and email to HRServices@csuci.edu or fax to 805-437-8491
WHO’S ELIGIBLE
Applicants must be CSUCI or Auxiliary employees and be able to document a hardship that is the result of a temporary situation.
This is defined as an acute financial setback as the result of a specific event (e.g. natural disaster, acute illness, death of immediate
family members, etc.).
POTENTIAL AWARD AMOUNT
Awards will be granted on a case-by-case basis up to $500. Payments made under this program are considered taxable income and
will be reported on the recipient’s W-2 form.
SELECTION
The Ekho Your Heart Committee will meet as needed to review applications and recommend to the President those selected to
receive funding. Awards will be granted on a case-by-case basis and may be subject to income tax.
All information pertaining to this application and subsequent award will be confidential to the extent allowed by law.
Questions may be directed to Human Resources at HRServices@csuci.edu, Lindero Hall 1804, or 805-437-8490.
*Emergency support for students is provided under the CSUCI Basic Needs and Emergency Intervention Program.
Internal Use: Employee __ yes __ no Approved __ yes __ no Award Amount: ________
EKHO YOUR HEART FUND APPLICATION
Please check one and complete ALL information in fields below.
Faculty Staff
LAST Name _______________________________ FIRST Name ______________________________ Middle Initial _______
Staff/Faculty ID Number __________________________
Current Mailing Address _________________________________________________________________________________
City ___________________________________________________________ State __________ Zip ___________________
Email _______________________________________________________ Telephone _______________________________
Amount Requested __________________________________________________
Please provide detailed answers to the questions below. Attach additional documentation if needed.
1. What is the situation that has affected you (check all that apply)?
Natural disaster
Acute illness
Death of immediate family member
Other
Please explain further in box below.
2. How will these funds assist you in meeting your needs?
I, the undersigned, certify that the information provided on this application is true.
Application Signature ___________________________________________________________ Date _______________________
Application Name (print) _____________________________________________________________________________________
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signature
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