Student Emergency Assistance Request Form "*" indicates required fields Student Name* Student ID* Phone*Email* Are you set to graduate this May?- Select one -YesNoAre you studying on an F1 Visa?- Select one -YesNoHow have you been affected by Covid-19?*Request for Personal Needs such as food, toiletries, etc.?*- Select one -YesNoHiddenBrief Description of RequestRequest for housing, tuition, or both?*- Select one -HousingTuitionBoth (housing, and tuition)Are you currently residing on campus?- Select one -YesNoAre you currently residing on campus?- Select one -YesNoPlease list your building & room number or address and apt/suite number Please list your building & room number or address and apt/suite number Brief Description of RequestBrief Description of RequestAre you currently enrolled in a Payment Plan- Select one -YesNoAre you currently enrolled in a Payment Plan- Select one -YesNoBrief Description of RequestBrief Description of RequestEmailThis field is for validation purposes and should be left unchanged. Δ
