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FPCC COVID-19 Emergency Student Funding Application

The COVID-19 Emergency Funding is available to you as a student to help pay for food, housing, Internet access, and other needs that are impacting your need to work on your education. We have a limited amount of money available, and there is a review committee that will determine how to distribute these funds. Completing this application does NOT mean that you will receive funding.

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* 1. Name:

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* 2. Which semester term are you submitting the application for?

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* 3. Date of Birth:

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* 4. Mailing Address:

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* 5. Phone Number:

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* 6. Email Address:

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* 7. Enrollment Status:

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* 8. Employment Status:

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* 9. Please attach copies of the most recent paystubs.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
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* 10. Income:

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* 11. Please attach copies of the most recent documentation of income.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
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* 12. Funding Request Needs:
*Note: Please provide any documentation you have for your funding needs (bills/receipts/statements, etc.) to Student Services at WEV Building or call (406) 768 6370.

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* 13. Explanation of Need: (statement on how Covid-19 has affected your life and needs)

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* 14. Check the one that most fits your household income.

  138% 150% 200% 250% 300% 400%
Size of Household: 1
Size of Household: 2
Size of Household: 3
Size of Household: 4
Size of Household: 5
Size of Household: 6
Size of Household: 7
Size of Household: 8
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