Your Information
Relief Fund is a monetary aid that students experiencing an unexpected financial hardship may apply for.
This request will be reviewed by a committee who examines need and availability of funds. This fund
can only be awarded once a year to a maximum of $250.
St
udents who have been approved will complete a case plan with the Case Manager in order to develop
financial independence.
1. Complete and sign all sections of this form. Information must be legible or typed.
2. Attach any supporting documentation explaining circumstances (i.e. medical bills, auto repair
estimate, etc.). All documentation will be verified for authenticity.
3. Submit completed form to the Case Manager. A mandatory interview with the Case Manager will
then be scheduled.
Name:_________________________ TCC SID#: ________________ Phone #(home/cell): ____________________
Amount Requested: $__________________ Semester in which the emergency occurred: ____________
How will you use these funds? (Check all that apply, then list the recipient of funds)
Transportation ________________ Utility Expenses_________________
Dependent Care____________________
Other (if all other options do not apply) ____________________________________________
Read and check all statements below, then sign to confirm that you agree with the following statements:
I affirm that all information on this form is complete, true, and correct and that I am in need of these funds in order to
continue my education at Tallahassee Community College
I understand this is a one-time award.
I understand that TCC may be required to share information with college representatives or grant sponsors.
_______________________________________________ _______________
Student’s Signature Date
Instructions
Eagle Relief Fund
Request Form
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signature
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Marital Status: Number of Dependents in Household:
Estimated Expenses (Per Month) Estimated Income (Per Month)
Rent/Mortgage
$ $
Food
$ $
Transportation
$ $
Utilities
$ $
Child Care
$ $
Phone/Cable/Internet
$ $
Other Expenses (i.e., prescription costs):
Expense: ___________ $__________
Expense: ___________ $__________
Other Resources (i.e., TANF, DARS, SSI…):
Resource:___________ $_______________
Resource:___________ $________________
Total Expenses Per Month
$
Total Income Per Month
$
Your Financial Information
Going forward, how will you manage your future financial needs?
If your expenses exceed your income, please provide a brief explanation for how you are supporting yourself.
Briefly describe the effect this financial hardship has had on your education
Submit
The Eagle Relief Committee reserves the right to review each request on a case-by-case basis. The
committee may request additional supporting documentation after the first review or the student may
provide additional documentation that was not seen during the first review.
Department of Student Services, Eagle Relief Committee
Tallahassee Community College
444 Appleyard Drive, Tallahassee, FL 32304
Office: 850-201-8420, Email: erf@tcc.fl.edu,
Fax 850-201-8427
This request has been:
Approved
Denied
_________________________________________ ___________________________
TCC Representative’s Signature Date
_____________________________________________ ______________________________
Printed Name Position
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signature
click to edit
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