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Klamath Community College Foundation
Student Emergency Fund
Grant Application
Please return this form to:
Klamath Community College Foundation
Attn: Patricia Springer (or via email to springer@klamathcc.edu)
7390 South Sixth Street
Klamath Falls, OR 97603
1. Date:
2. Name:
3. Address:
4. City: State Zip Code
5. Phone:
6. Email:
7. Student Identification Number:
8. What amount you are requesting? (minimum award is $25 and maximum award is $250):
9. Please describe why you need this funding and how this emergency is affecting your education?
10. If awarded, how would you utilize these funds?
11. What else have you done to secure emergency funds from other sources?
12. Please share how you learned about this grant.
I certify that all information I have provided on this form is true to the best of my knowledge.
Signature
Name (Please Print)
Date
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