Crisis Fund Application

Crisis Fund Application

If you have applied for financial aid, please attach a copy of your award notification. Applications must be fully completed or they will not be reviewed for funding. For questions regarding crisis funds, contact the Carl Sandburg College Foundation at foundation@sandburg.edu or 309.341.5349.
Name*

First NameLast Name
Carl Sandburg College Student ID#*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Sandburg Student Email Address*
Degree/Certificate Program*
Grade Point Average*
Please choose any financial support or income currently being received. (Select all that apply)*

Sandburg Foundation ScholarshipsExternal, Non Sandburg ScholarshipsFinancial Aid, including Pell and Map GrantsNo current financial support or income.Other Form(s) of Financial Support
If other, please describe those forms of financial support.
Name of Sandburg academic advisor*
Number of Hours Presently Enrolled*
Have you communicated with Sandburg staff/faculty about your needs/hardships/emergency? (Choose one)*

YesNo
How did you learn about the Crisis Grant program?*
Amount of Assistance Requested ($500 is the maximum amount funded)*
Please provide a detailed description of the crisis you're experiencing in the space provided. *
Please explain how a crisis grant could help further your educational experience at Carl Sandburg College. How will this opportunity help you finish your studies at the College?*
What efforts have you made to obtain funding from other sources and have you been successful?
Please include/attach copies of any and all supporting documentation. (Examples include, but are not limited to: medical bills, proof of unemployment, foreclosure, eviction) Documentation is REQUIRED.

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If your request is vehicle related, please fill out the following information. If not, please skip ahead to the check-receiving question.
List the make, model, and year of your vehicle
Please upload a copy of your vehicle registration

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Please take a photo of your vehicle identification number (VIN) on your vehicle and upload the image in the space below. The VIN is typically located in the driver's side doorjamb, on the dashboard inside the windshield (lower, driver's side corner), or on the engine block.

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If awarded funds, how would you like to receive your check:

By mail (check will be mailed to the address provided above)I prefer to pick up my check in the business office
Affirmation: I have read and understand all criteria and requirements regarding Carl Sandburg College Foundation's Student Crisis Funds, and I certify that all information I have supplied on this application is correct. I understand that applying does not guarantee approval, and that applying does not obligate the Sandburg Foundation to award me funds. I hereby authorize the appropriate individuals to review my student records and disseminate information to the Student Crisis Fund Committee by e-mail as necessary. I understand that the information I have submitted will be handled privately and will not be shared beyond those with a distinct need to review my application. I also understand that those individuals may contact me for further information. I understand that checking this box signifies agreement with the policies outlined in this application. I also understand that, while Carl Sandburg College goes to great lengths to ensure that my information is secure, electronic submission of this information is at the sole risk of the applicant if I choose to submit electronically.
I have read and understand the above affirmation statement. Typing my name serves as my electronic signature:

Clear
Please note:
Crisis Grant Applications are reviewed regularly by a committee. Checks are produced in the Sandburg Business Office and dispersed on Thursdays only. Students awarded a grant will be notified via their Sandburg student email account.
Should be Empty:

Crisis Fund Application

If your request is vehicle related, please fill out the following information. If not, please skip ahead to the check-receiving question.