COVID-19 Emergency Assistance Request Form | University of Montana Western

The COVID-19 Emergency Assistance fund helps currently enrolled students with extraordinary one-time costs that have arisen as a result of the COVID-19 pandemic. At this time the maximum amount of emergency assistance that will be provided from this grant is $800.

Eligibility Requirements Per Federal Regulations:

1.) Have completed FAFSA for 2020-2021

I understand that by checking this box I have submitted a FAFSA for 2019-20. I acknowledge that if I check this box and have not submitted a FAFSA, I am not eligible to receive CARES Act Funds. If you need to submit a FAFSA, visit https://studentaid.gov/h/apply-for-aid/fafsa before submitting this form to ensure your eligibility for CARES Act Funds. *

Yes, I agree with this statement.

Name *

First

Last

8000# *

Funds Requested

Basic Needs

Food
Housing and moving expenses (rent, storage, etc.)

Amount:

Education-Related Expenses

Technology for online classes
Transportation (unexpected travel costs, etc).
Childcare

Amount:

Other Expenses

Healthcare and medical expenses
Other (please list in text-box below)

Description of Other Expenses:

Amount:

Explanation of Funds Requested

Was your housing affected due to the COVID-19 pandemic? *

Yes
No

If yes, please explain:

Do you plan to return to UMW? Please select one of the choices below. *

By checking the box below, I certify that to the best of my knowledge the information I provided in this form is true and complete without evasion or misrepresentation. *

Yes, I agree with this statement.