Emergency Assistance Fund Application

First Name: *
Middle Name: *
Last Name: *
- Maximum Amount: $500 (per student per academic year)
- $1,000 lifetime maximum award per student
- Please note that amounts are paid directly to vendors ONLY (i.e., property manager, utility company, etc.)
Amount Requested: *
WVNCC Student ID: *
Have you applied for Free Application for Federal Student Aid (FAFSA): *
Have you applied for Free Application for Federal Student Aid (FAFSA)Yes
No

Address: *

City: *

County: *

State: *

ZIP: *

Phone: *
Contact Preference: *
E-mail: *
By Clicking I agree I attest that the statements made on this application are accurate to the best of my knowledge. If approved for funds, I understand that I cannot be awarded more than $500 per request. I also allow infor- mation regarding my student account to be released to the members of the committee. This information includes, but is not limited to: financial aid account information, student award and refund information, and student academic information, including GPA and academic progress: *
By Clicking I agree I attest that the statements made on this application are accurate to the best of my knowledge. If approved for funds, I understand that I cannot be awarded more than $500 per request. I also allow infor- mation regarding my student account to be released to the members of the committee. This information includes, but is not limited to: financial aid account information, student award and refund information, and student academic information, including GPA and academic progressI agree
Please tell us about your situation, or hardship, along with your financial request. : *
Please provide official documentation verifying situation. In addition, attach a reference letter from a WVNCC faculty/staff member or financial aid/counselor.: *
(Acceptable Formats: .pdf, .doc, .docx, .xlsx, .png, .jpg, .jpeg, .gif, .tiff)
Name of person making recommendation: *

* = Required

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