DOWNLOAD AND SAVE this form on your desktop/laptop.
Mailing Address:
State Zip
Date of Birth: Empl ID: Email:
Cell Phone #:
Alternate Phone #:
Semester/Year Funding Needed: Amount Requested: $
Type of Assistance You Are Requesting:
¨ Transportation
What type of assistance you are seeking
Why you are in need of assistance (feel free to share as much or as little as you would like)
How receiving f
inancial assistance will help you to complete the semester
If requesting textbook assistance, include the full name of book, author, and price of textbook
SIGNATURE: By typing my name below, I attest that the information I have provided in making this request is accurate. The Foundation is providing this award
because it is committed to seeing you graduate, believes that you have a bright future ahead and that you are going to make a difference in this world. I
acknowledge the vote of confidence being provided by the Foundation and in return pledge to the Foundation and to myself that I will make every effort to utilize
any support granted to me to successfully complete my course work this semester, so that I can stay enrolled and eventually graduate.
Name Date Completed:
LaGuardia Community College Foundation Emergency Fund Request Form
¨ Texbook
¨ Other
WRITTEN STATEMENT: Tell us why you’re seeking assistance. Be sure to include:
SUBMIT: Save this completed form to your desktop/laptop. E-mail as an attachment to with
any necessary documentation. Click here for a list of required documents.
QUESTIONS? E-mail us at
Are you currently receiving LAGCC Foundation assistance? Specify:
Are you currently receiving federal government benefits? (i.e.: Public Assistance or SNAP) Specify: