Name *

G-Number: *

Email Address: *

Phone Number: *

Major/Program: *

Expected Graduation Date: *

Emergency Details:

In the box below, please:

• Describe the nature of your financial hardship. What led to this emergency situation, and how is it impacting your academic and/or personal life?
• Indicate the amount requested (up to $1000 per student, based on fund availability):
• Indicate what specific expenses will this assistance cover? Please be as detailed as possible.

Emergency Details Response *

Financial Needs Assessment:

In the box below, please indicate if you:

• Have you applied for or received any other financial assistance for this hardship (e.g., GVSU emergency fund, scholarships, loans)?
• Describe any additional sources of financial support you have accessed or explored.

Financial Need Assessment Response *

Has someone in your household or connected with this emergency request applied for this fund? *

Supporting Documentation (this is REQUIRED):

• Upload any relevant documents (e.g., bills, estimates, or proof of expenses) that would help in assessing your financial need.

Supporting Documentation Upload *
Please upload a file with the extension .doc, .pdf, .rtf, .pages, .docx, .odt, .pub, .bmp, .gif, .jpeg, .jpg, .png, .tiff, .webp, or .txt with a maximum size of 1 MB (1024 KB)

 Please note that it may take up to 3 business days to review your application, and additional time may be needed to process the funds.

I confirm that all information provided is accurate and complete to the best of my knowledge. Sign your name and today's date