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•
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Office
of
Financial
Aid
UNIVERSITY
OF
COLORADO
BOULDER
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Student Relief Fund Emergency Grant
Application
Name: ID:
Student’s Name (Last, First, M.I.) Student Identification Number (SID)
This form may be completed by enrolled students who are either in danger of withdrawing due to an
unexpected, temporary financial hardship resulting from an emergency or crisis situation; or are struggling with
debilitating financial circumstances which may impede their academic progress and ability to complete classes.
Students who are eligible for federal or state financial aid are not eligible to receive the emergency grant.
Email address: Cell Phone number:
Current local address (street, city, state, zip):
What is your current class level? Freshman Sophomore Junior Senior Graduate Law
Expected date of graduation (term & year):
Are you eligible for federal or state financial aid? Not sure? Visit https://studentaid.ed.gov/sa/eligibility/basic-criteria.
The emergency grant is only available to students who face a legal barrier to accessing federal or state financial aid.
Yes (you are not eligible to receive the emergency grant)
No (continue to next question)
Emergency grant amount requested: $
Please explain why you need emergency financial support. If needed, attach additional pages with your
name and SID. Submit any supporting documentation that demonstrates your situation along with this form (i.e.
child care receipts, medical bills, etc).
Explain how you are currently addressing your financial need and what sources you have utilized:
What do you plan to do if you do not receive an emergency grant?
By signing this form, I certify that the above information is complete and accurate and I agree to provide receipts and/or other
documents requested in support of this application. In addition, I understand that submission of this application does not
guarantee that additional assistance will be awarded.
Student signature Date
Electronic and typed signatures are not acceptable.
Please submit your form in-person to the Office of Financial Aid/Scholarships, R
egent 175,
or by fax to 303-492-0838 • www.colorado.edu/financialaid
B - FA - MISC Documents > B - FA - Emergency Grant Application
Aug 18
