The Program
The CT Foundation Emergency Fund Program was established to assist currently enrolled CTC students who are in an
emergency situation and at risk of not continuing their education due to unexpected financial dilemmas. The Foundation
is committed to supporting student success. A student may be assisted through the emergency fund one time only.
Eligibility
Applicants must meet the following criteria:
Student must be enrolled during the semester he/she makes the request.
Cumulative GPA must be 2.00 or higher.
Student must have completed at least 9 accumulated credit hours at CTC.
Student must demonstrate “emergency” financial need.
Funds are limited to a maximum of $500 paid directly to a vendor. Please include an invoice with the vendor's
name and mailing address with your application.
All other sources of financial assistance must be exhausted before making an application for funds.
A student cannot be on Financial Suspension (less than 67% completion).
A student may not have been a recipient of the fund in the past.
A student is granted assistance only once during their tenure at the college.
Application Process
Interested students must complete the application and attach supporting documentation. Please answer all questions as
completely as possible; all applications are evaluated on information supplied. Student must secure one (1) letter of
recommendation from CTC faculty or staff. Have the letter sent directly to the Foundation at
foundation@chattahoocheetech.edu
. Incomplete applications will not be evaluated.
Payments
If approved for funding, payment will be made directly to the vendor.
Obligations
Student must agree to allow faculty and staff of Chattahoochee Technical College to provide additional information
regarding current and previous academic record(s) and financial aid applications and/or awards. Recipients may be
asked to participate in follow-up studies or promotional efforts.
Additional Information
Submit application and all documentation to: Chattahoochee Tech Foundation, Marietta Campus, Bldg. A
980 S. Cobb Dr., Marietta, GA 30060 or via email at:
Foundation@chattahoocheetech.edu.
Questions? Call 770-528-4461
Do not return this instruction page with your application.
A Unit of the Technical College System of Georgia
An Equal Opportunity Institution
6/28/16
Student Emergency Assistance Grant Application
For unexpected expenses
Student’s Name Application for Emergency/Special Funds 6/28/16
EMERGENCY FUND APPLICATION FORM
Please Print Clearly
Applicant Data
Student Name: _____________________________________________Date:______________
Student ID #: _____________________________________________________________
Mailing Address: __________________________________________________________
__________________________________________________________
Phone Number(s): Hm:_________________Cell: _____________ Wrk: ______________
Email Address(s): _________________________________________________________
(Please use email address you frequently check.)
Current College
Data
Enrollment Status: Full Time ______ Part Time ______
Program of Study: _________________________________________________________
In which type of program are you currently enrolled?
Technical Certificate _______ Diploma ______ Associate Degree ______
When did you start CTC? __________ Anticipated Completion Date: _______________
Cumulative GPA: ______
Main Campus You Attend: __________________________________________________
How many semesters have you attended CTC? (even if not sequential) _____
Name of your Advisor: _____________________________________________________
Goals and
Aspirations
What are your plans as they relate to your future educational goals and aspirations?
______ Earn college credits and transfer to another college to earn a 4 year degree
______ Graduate from CTC/enter workforce
______ Other (briefly explain): __________________________________________
Page 1
Student’s Name Application for Emergency/Special Funds 6/28/16
Assistance
Request
Please briefly explain what you are seeking assistance for:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Amount of funds Requested: $ _____________
Include copies of receipts/price lists from vendors if requested funds are for specific needs such as book
purchases.
Financial
Information
Are you receiving the Pell Grant for the current year? ____________________________
If so, how much were you awarded? __________________________________________
Are you receiving the HOPE Grant/Scholarship for this current year? ________________
Are you currently receiving any other scholarships or financial aid? __________________
Have you applied to this Foundation for emergency funds before? __________________
If so, how much assistance did you receive? ________ When? ______________________
How were the funds used? __________________________________________________
Are you currently employed?
Full Time ______ Part Time _______ Varied schedule _________
How long have you been employed there? __________
Employer: ______________________________________________________________
Title: __________________________________________________________________
How many members of your household for which you are responsible: _____________
I have already received assistance from:
Textbooks (Lending Library) ______ Community Resource Referrals ______
Work Study ________ Disability Services _______
Food Stamps ________ TANF _______ Medicaid ________
Other (list) __________________________________________________________
Communication
How did you learn about the Foundation Emergency & Special Funds Program?
Page 2
Student’s Name Application for Emergency/Special Funds 6/28/16
Brief Letter or Essay
Attach a brief letter or essay addressing your needs (no more than two pages in length, please) and attach
any pertinent documents that support your request (copies of college tuition statement, bookstore printout,
copies of bills, copies of workshop registration fees, etc.)
Your letter or essay must be typed.
Please provide as much detail as possible.
In your statement, please tell us:
What are the circumstances that brought you to apply for the Foundation Emergency Fund Grant?
What are the funds to be used for?
What other types of assistance have you sought?
What you will do to cover such expenses in the future.
How will this award allow you to continue your education and help you achieve your goals?
Application
Checklist
Page 3
Certification
Signature
required
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