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CARES Act Higher Education Emergency Relief Fund Application Form
The U.S. Department of Education has made available CARES Act Emergency Relief Fund that South Baylo University can distribute
to students that are eligible to receive Title IV Financial Aid and who need nancial support for their qualied expenses related to the
disruption of campus operations due to the COVID-19 pandemic (including education expenses, course materials, technology, food,
housing, healthcare and childcare). This application form allows students to request these need-based grants. The Oce of Financial Aid
will use the information you provide below to determine the amount you will receive.
Once the completed form has been received, we will begin the process to award and mail a check to the address in the school portal.
Please respond as soon as possible. Fill out the information requested below on this form and email it to mimi@southbaylo.edu. Please be
advised that your current mailing address, email and phone number in this form will be used for processing this fund and will be updated
in our record.
Name of Student: _______________________ _______________________ _______________________ Student ID #:____________
last rst middle
Email: ________________________________ Phone #: ___________________ Program Enrolled: [ ] MSAOM [ ] DAOM
Mailing Address: _______________________________________________City:_______________State:___________ Zip:_________
Check all expenses that you have incurred:
[ ] Education expenses / Course Materials / Technology
[ ] Food / Housing
[ ] Healthcare / Childcare
[ ] Job loss / Furlough
[ ] Other. Please provide details:
I attest that all information is true and accurate, and I am requesting a one-time CARES Act Higher Education Emergency Relief Fund
to help cover the cost of expense incurred due to the COVID-19 pandemic. I understand that I can not revise this request after submitting
it, and I understand that the Oce of Financial Aid will determine my eligibility for grant monies based on my responses to the questions
above.
Student’s Signature: _____________________________ Date: _____/_____/_________
Submit this application to the Oce of Financial Aid via email at mimi@southbaylo.edu.
ADMINISTRATIVE USE ONLY
Date of Application Received: _____/_____/_________ Date of Application Reviewed by FA Oce: _____/_____/_________
Student Eligibility Amount:___________________ Date of Check Mailed: _____/_____/_________
ERA
