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
Request Form
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signature
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