TCC Great Expectations Gas Card Application

Name*

First Last

SIS Number*

Do you currently work?*

Yes
No

If so, how many hours per week?*

Have you requested an HRT GoSemester from Great Expectations?*

Yes
No

Please briefly share why you are requesting assistance with gas*

I agree to use the gas card provided to me by the Great Expectations program for gas purchases only. I understand that it is non-transferrable. I will provide a detailed receipt to the Great Expectations Coordinator within 5 business days of the purchase. Failure to provide a gas receipt could jeopardize my future financial support from the Great Expectations program.*

I agree

Signature*