Vernon College Foundation

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Emergency Aid Application

Email *

Who referred you to this program? *

Full Name *

Student ID *

What is your field of study/program?

Amount Requested *

Current Cumulative GPA *

Phone Number *

Mailing Address *

Student Email *

Personal Email (optional)

Applicant must be enrolled full-time or part-time in credit courses, minimum 6 credit hours during the semester or a THECB Continuing Education Approved program. Each application will be reviewed and consideration by the Vernon College Student Emergency Aid Committee.

-In a short paragraph (2-3 sentences) describe in detail the nature of your emergency. Tell us why emergency funds are needed to successfully complete your current courses or workforce program.
-Email supporting documentation to support this request to scholarships@vernoncollege.edu. Examples may include but are not limited to invoices for books, uniforms or other required course supplies, statement of tuition balance.

What is the nature of your emergency request? *

Automotive Repair

Gas/Transportation

Utilities

Rent Assistance

Food

Childcare

Other:

Required

Describe nature of emergency here (please be as descriptive as possible): *

Are you currently receiving financial aid? *

Yes

If yes, what type? List all and dollar amount of each type: (grants, loans, scholarships) *

Please check each box below: *

I acknowledge that the above information is true and correct to the best of my ability.

I understand that falsifying information will result in denial or consideration for aid.

I authorize Vernon College to release any pertinent information concerning my college records to the Vernon College Student Emergency Aid Committee as needed.

I understand that Emergency Aid is intended as a one time award

Required

Signature and Date *

Submit

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