Financial Aid Office
Phone: (208) 524-3000
Toll Free: 1-800-662-0261
Fax: (208) 525-7026
1600 S. 25
E. Idaho Falls, Idaho 83404
First Name
Last Name
Student ID
Phone Number
Mailing Address
Email Address
The purpose of the Emergency Funding Grant is to provide additional one-time funding to students who are at risk as a
result of the COVID-19 health crisis and change to remote instruction. Our Administrators, Faculty and Staff are here to
help you. The information you provide will remain confidential.
Emergency Funding Eligibility Requirements: A current degree seeking student at CEI, attended the Spring 2020 term,
registered for six (6) or more credits, making Satisfactory Academic Progress, be eligible to participate in Title IV
In order to be eligible for the Emergency Funding Grant, a student must be Title IV eligible. You may be required to complete the
CARES ACT Grant Application & Determination of Title IV Eligibility.
Are you currently admitted at CEI as a degree seeking student? Yes No
Please indicate which semester you are/were enrolled or intend to enroll at CEI?
Check all that apply: Spring 2020 Summer 2020 Fall 2020
How many credits were you enrolled in the Spring 2020 term? __________________
Marital Status: Married Single Separated Divorced
Number of Dependents: _______________ Ages of Dependents: ________________
Financial Information:
Have you completed the 2019-2020 FAFSA Yes No
***If you answer ‘No’ you will be required to complete the CARES Act Grant & Determine of Title IV Eligibility
Have you received a Pell Grant in Spring 2020? Yes No
Have you received a Student Loans in Spring 2020? Yes No
Have you received a Scholarships in Spring 2020? Yes No
Are you in Default on any Student Loans? Yes No
Do you owe an Overpayment of Title IV aid? Yes No
Please indicate how the COVID-19 pandemic has impacted you and/or your family. Please Check all that apply:
Food Insecurity
Housing- Living at a temporary residence or have additional person(s) living in your household, etc.
Course Material- such as lack of computer/laptop access at home, etc.
Distance Based Technology - Lack of or limited internet access at home, etc.
Health Care- COVID-19 related illness/medical bills for self and/or family.
Child Care Expenses- Lack of child care and/or school aged children at home requiring supervision, etc.
Job Loss- Income or wage loss due to COVID-19 and/or stay at home order, etc.
Emergency Funding Grant
Please tell us how COVID-19 has created financial burdens, or barriers to your ability to complete your current semester
courses as listed above.
Please provide the specific $ amount you are requesting? * Note this request of funds is not a guarantee.
What will you use these funds for and how will they help you complete a semester course(s) successfully?
Do you have additional educational concerns or financial hardships that have impacted you while attending the College
of Eastern Idaho due to the COVID -19 pandemic?
Acknowledgement & Signature:
I understand that if awarded Emergency Grant Funds, this is a one-time award. I acknowledge that by completing and submitting
this form, I am not guaranteed to receive emergency grant funding nor the total amount I have requested. I understand that if I do
not have a completed, approved FAFSA on file at CEI, I will be required to submit all requested documents for the evaluation of my
Title IV eligibility to be awarded emergency funding. By signing this form I am stating that I understand and accept the terms and
conditions of the CARES Act. I understand, as noted above, I will use the emergency funds for the requested hardship. Emergency
funding is limited and will be based on student requested need. Funds will be distributed on a first come first serve basis until funds
are exhausted.
I am stating that the information provided is true and correct. I understand this application request will go through the standard
process for consideration. Allow 3-4 weeks for processing.
* By typing my name below, I am providing my digital signature and certify that the above information is correct.
Student Signature: Date:
WARNING: If you purposely provide false or misleading information, you may be subject to a fine, imprisonment, or both.