Emergency Funding Request

Personal Information.

First Name: *

Last Name: *

Preferred Name:

Preferred Pronoun:

Email: *

(All communication will be through email)

Date of Birth: *

Expected Graduation Date (mm/yy): *

Amount Requested: *

A personal statement addressing the items below.

Please describe the emergency that occurred and the specific unforeseen expenses that resulted. Explain how these expenses relate to your ability to remain enrolled and successfully complete your current academic quarter. *

I am requesting funds to assist with the following emergency expenses that could prevent me from continuing my education: *
(Select all that apply)

Housing.

Food.

Transportation.

Technology.

ChildCare.

Medical.

Utilities.

Books/Supplies/Tools.

None of the Above.

In addition to Emergency Funding, there may be other funds or support services available to assist you. Please let us know if you are receiving any of the following (this information will not impact your Urgent Funding determination): *
(Select all that apply)

DSHS Food Benefits.

TANF.

Unemployed or currently laid off.

Veteran's Benefits.

None of the Above.

How did you hear about the emergency funding program at BTC? *

Email.

Flyer.

Staff.

Faculty.

Another BTC student.

Digital sign.

Other.

I certify that the information above and in my accompanying personal statement is true and correct to the best of my knowledge.

I have read this form carefully. I understand that an incomplete request may not be processed.

Please enter your Student ID (ctcLink EMPLID) (9 digits) for verification:

Student ID (ctcLink EMPLID)     

Please click the "Save/Submit" button only once. this may take a minute to process

Requests will be reviewed within 7 business days from submission. Results or requests for additional information will be communicated via email.

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