Emergency Fund Scholarship Application – SUNY Polytechnic Institute Forms

Please complete the following questions to the best of your ability, providing as much detail as possible telling us why you are requesting emergency funding from the SUNY Poly Foundation. Your statement of need should clearly define your immediate and current emergency, and describe the life circumstances that have contributed to this situation.

STUDENT EMERGENCY FUND
The Student Emergency Fund provides grants for SUNY Polytechnic Institute students to pay for unforseen urgent financial expenses, including those associated with the COVID-19 pandemic. The need must threaten the student's ability to stay in school.

All questions must be answered in order for your application to be completed and submitted.
ELIGIBLE EXPENSES
- housing changes or threat of eviction
- medical emergency
- domestic violence
- theft
- loss or change in employment
- transportation
- computer repair
- back up childcare
- family abandonment
Name * Required
First Last
Student ID Number * Required
Address * Required
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone (Cell) * Required
Phone (Home) * Required
SUNY Poly Email * Required
Personal Email * Required
Enrollment status * Required
- Registered
- Not registered
Degree Program * Required
Credits earned to date * Required
Credits in current term * Required
Did you withdraw from any courses due to COVID-19? * Required
- Yes
- No
If yes, please explain?
Do you live: * Required
- On campus
- Commute to campus
- Online only
Current employment status * Required
Statement of Need
Amount of funding being requested * Required

You must show evidence of expense (ex: bill).
Please provide a summary of why you are requesting funding * Required
In which term is this application being processed: * Required
I certify that all of the above answers are true and complete to the best of my knowledge. I give permission to SUNY Polytechnic Institute to share my answers and digital information with scholarship selection committee members. Please enter your full name as a digital signature to confirm you agree: * Required
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STUDENT EMERGENCY FUND

ELIGIBLE EXPENSES

Statement of Need