Student Name: ______________________________
Date of Birth: ______________________________
Phone Number: ______________________________
Email Address: ______________________________
Please provide a brief statement explaining why you are requesting Student Emergency Funds.
Please list the expense(s) and amount(s) for which you are requesting assistance.
Please provide a brief explanation of your financial circumstances, and describe your efforts to obtain
funds through other sources.
Student Certification
By typing my name below, I certify that:
The information is complete and accurate
I will use Student Emergency Funds only for the purposes specified
I will reimburse Babson College if the funds, or some portion of the funds, are no longer needed
or if funding is provided to me from another source, e.g., insurance
I will submit receipts or other documentation as requested
Name: ___________________________________ Date: ___________________
Faculty/Staff (if applicable)
We encourage students to submit their own requests for Emergency Funding. If you feel it is warranted,
however, and if the student has consented to this request being submitted, we will accept the
application from you. We will follow up directly with the student.
Faculty/Staff Name: ________________________________________
Faculty/Staff Phone Number (work): ___________________________
Faculty/staff Phone Number (cell): ___________________________
Please send the completed form to Meredith Stover, Director of Financial Aid, at
Students will receive an acknowledgment by email, typically within 1 business day, with information
about any next steps. Next steps could include a face-to-face meeting with one of the Emergency Fund