Request for COVID-Related Student Emergency Assistance Funds

Your Name*

First Last

Student ID*

TCC Campus*

TCC Email Address*

Phone Number*

Current Mailing Address (must match your address on file at TCC)*

Do you have a child/children under the age of 18 at home?

Are you enrolled in the CAPS Program?

Are you employed at TCC in any capacity?

Have you completed a Single Stop profile?

Have you previously received emergency assistance funds?

Please indicate the SREC Case Manager you are working with:

Do you have a Nelnet account?*

Yes
No

Dollar amount requested*

Reason for Need*

Books
Car Repair
Child Care
Commencement Regalia
Other
Rental Deposit
Transportation
Utilities

Please indicate your reason for needing student financial assistance.

Please use the space below to describe the future financial plan that you discussed with your SREC Case Manager.*

By initialing below, you agree to provide your SREC Case Manager with all required documentation needed to support your request, including a W-9 form which is required for all requests.*

By initialing below, you understand that financial assistance funds you receive may count as income and may be subject to federal and/or state taxes.*

Request for COVID-Related Student Emergency Assistance Funds

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