Emergency Funding Request Form : Dean of Students Office : Texas State University

Qualifications Check List *

Currently enrolled

Undergraduate or graduate student at Texas State

Can provide documentation about both the emergency event and the financial consequences

Exhausted all other financial resources

Including Financial Aid loans and grants

First and Last Name: *

Texas State ID# (A0.......): *

Texas State email: *

Phone number: *

How did you find out about emergency funding assistance? (check all that apply)

FACES program

Friend

Instructor or staff member

Students Who Are Parents (SWAP) program

Website

Other

Are you a veteran? *

Are you currently employed? *

Have you applied for Financial Aid? *

Have you ever applied for emergency financial assistance from Student Emergency Services? *

If yes, please give the semester and the amount received.

Amount Requested (Up to $400) *

Please provide a brief description of the emergency (unforeseen) event. Please include the supporting documentation as an attachment below. *

Attachment 1 *

Attachment 2 (Optional)

*

I attest that all of the information provided here is accurate and true.