Emergency Fund Application

Please complete all applicable information

First Name *

Last Name *

Date mm/dd/yyyy *

Email *

Phone *

Mailing Address: Address you would want your grant mailed to if your application is approved

Address 1 *

Address 2

City *

State *

Zip *

College or University you are attending *

Year of Snow Scholarship *

How would you like to be notified of your emergency fund status? *

By what date do you require the emergency funds? *

Please explain in your own words why you need emergency assistance. Be specific. *

Please itemize your specific financial needs below *

Total amount requested $ *

Applicants Affidavit

I hereby affirm that the information I have supplied on this application is true and correct and that I have attached all relevant bills, invoices, and receipts to substantiate this application.

Signature of Applicant *

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Timeout Warning

Emergency Fund Application