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Self-Certification Form
This form must be completed to verify eligibility of Grossmont Higher Education Emergency Relief Funds
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Student ID #
*
Your answer
I’ve incurred at least $500 in additional expenses due to COVID-19 in one or more of the following areas:
*
Housing costs such as mortgage or rent
Technology expenses for taking on-line courses such as: software, internet or computer hardware
Food
Utilities
Child Care
Health care expenses not covered by insurance
Miscellaneous costs such as: cleaning supplies and hygiene products
Required
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