The Emergency Grant Fund seeks to assist eligible students coping with recent, unexpected hardship, so that they may
continue their education at Kingsborough Community College without interruption. The Fund’s long-range goal is to use its
financial resources to help the widest range of students succeed in graduating from college.
The purpose of the Emergency Grant Fund is to enable matriculated students in good academic standing and who meet the
basic eligibility for federal “Title IV” financial aid and who are experiencing short-term financial emergencies to remain in
school. Students who demonstrate need and are facing a current emergency may apply for a grant.
The information requested below will help determine your eligibility for this grant. Please note that your application must
be complete in order to be given consideration. Completion of this application is not a guarantee that you will be
awarded funds.
If approved, you will receive a notification letter from the Office of the President detailing how you will receive the funds
and the deadline for submitting your letter of appreciation.
Please note that funds cannot be awarded for:
1. Previous debts to college
2. Full or partial tuition/fee costs
3. Legal representation in a criminal proceeding or Kingsborough Community College disciplinary proceeding
Please Print or type:
Date of Request: Amount Requested:
Applicant’s Name: KCC Empl ID: ______
Current Mailing Address: ______
Credits Completed: Major:_______________________________ GPA:_____________
Cell/Home Phone: Email Address:
1. Attach a 1-page statement explaining your emergency and describing how the funds will be used to alleviate the
situation. Please itemize each cost and provide a total of requested amount. Lastly, please provide a “plan of action”
for how you intend to cover these expenses moving forward.
2. Please provide a form of documentation to support your emergency request. Examples of acceptable documents
include medical bills, bank statements, letter from employer stating your loss of job, letter from your landlord stating
rent owed or loss of housing, police report for theft, etc.
3. If you are denied the grant, would you be interested in an alternative scholarship?
4. If this is not the first time you have applied for emergency funds from Kingsborough Community College, please
indicate when and what funds you have requested and received.
{turn page over for more important information}
I, the undersigned, certify that the information provided on this application is true.
Applicant Signature:
Applicant Name (please print)
By accepting money from this fund, you agree to the following terms:
Applicant Agreement
I understand that the falsification or distortion provided in my application for the emergency grant or in the
subsequent report could jeopardize funds for students in the future. Such action may subject me to disciplinary action
by Kingsborough Community College.
I am aware that In the event that the total amount of your award totals $600 or more during a calendar year, a
Form 1099-Misc may be issued to you at year-end, governed by IRS regulations.
I have read and understood the above agreement. I agree to the terms and conditions of the award, and I warrant that any
and all representations made by me are true and to the best of my knowledge.
Student’s signature: Date:
Student’s name (please print or type)
To be filled out by the Scholarship Committee: Semester: ____________ Balance: ___________
EFC:______ Financial Need: __________ Pell: $__________ Scholarship Amount: $_____________ Approved by: __________
Please email completed application, essay and documentation to:
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