CARES Act Emergency Grant Application

Scholarship Terms and Conditions:

This application is for emergency funding available to current Southern State students attending fall semester to address the financial needs faced with unexpected expenses as a result of the COVID-19 virus. Emergency Grant assistance for allowable expenses will be provided in accordance with institutional policy and based on the guidance provided by the US Department of Education. The emergency grant can be used for expenses related to the disruption of campus operations as a result of the coronavirus such as food, housing, course materials, technology, health care and child care.

Applicant Information:

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* 1. Name:

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* 2. SSCC Student ID#:

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* 3. Please check all appropriate expenses as a result of the COVID-19 crisis:

Child Care (up to $300)

Medical / Health Care (up to $300)

Lab / Clinical Cancellations (up to $300)

Lack of Access to Course/Materials Due to Technology Issues (up to $300)

Food/Housing (up to $300)

Other (please specify)

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* 4. Provide an explanation of how the funds will be used:

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* 5. Amount requested $:

Note: Amounts are awarded in accordance with established eligibility criteria and availability of funds. There is no guarantee that the amount requested will be awarded.

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* 6. Contact Information:

Address

City/Town

State/Province

ZIP/Postal Code

SSCC Email Address

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* 7. I acknowledge that all of the information provided is true and complete to the best of my knowledge. I understand that I may be required to provide further information. I further acknowledge that my printed name in item number 8 constitutes my digital signature.

CARES Act Emergency Grant Application

Question Title

* 1. Name:

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* 2. SSCC Student ID#:

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* 3. Please check all appropriate expenses as a result of the COVID-19 crisis:

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* 4. Provide an explanation of how the funds will be used:

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* 5. Amount requested $:

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* 6. Contact Information:

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* 7. I acknowledge that all of the information provided is true and complete to the best of my knowledge. I understand that I may be required to provide further information. I further acknowledge that my printed name in item number 8 constitutes my digital signature.

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* 8. Name:

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* 9. Date: