If you have not already done so, please read the guidelines for this fund on this web page.

This form may be completed by enrolled students who are either in danger of withdrawing due to an unexpected, temporary financial hardship resulting from an emergency or crisis situation; or are struggling with debilitating financial circumstances which may impede your academic progress and ability to complete classes.

First name

Last name

Cell Phone

Street Address

Address Line 2

City

State / Province / Region

Postal/ Zip Code

Country

What is your current class level?

Freshmen Sophomore Junior Senior

Please explain why you need emergency financial support. In order for your request to be considered you must submit any supporting documentation that demonstrates your situation along with this form (i.e. child care receipts, auto repair receipts, etc.) Please put your name and student ID number on all supporting documentation. The costs must have been incurred while enrolled at CU; costs for a past or future academic year will not be considered.

Explain how you are currently addressing your financial needs and what sources you have utilized

What do you plan to do if you do not receive an emergency grant?

Upload your documentation

Select a file

By electronically signing this form, I certify that the above information is complete and accurate, and I agree to provide receipts and/or other documents requested in support of this application. In addition, I understand the submission of this application does not guarantee that additional assistance will be awarded.

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Date

Student Relief Fund Grant Application