College of the Canyons

Financial Aid - Emergency Grant Application

First Name

Last Name

Street Address

City

State

ZIP Code

Phone

Have you completed a FAFSA or California DREAM Act Application?

Yes

I am not eligible for FAFSA or DREAM Act

Have you completed a BaNC Registration form?

Yes

Please describe each of the following in SPECIFIC DETAIL in your request:

Describe the specific unexpected financial emergency that has arisen.
State in specific detail what exact expense you are seeking aid to cover. Supporting documentation must be attached to this form for the expense you describe.
If applicable, please include specific deadlines or timelines.

Request Details

Documentation to support the aid requested is required (Example: Copy of eviction notice or letters from landlords or mortgage companies, past due rent, mortgage or utility bill, rental agreement or bill, vehicle repair bills, monthly bus or metro pass invoice, child care payment or invoice etc.), and should be attached to the end of this form.

You may upload documents, pictures (including screenshots), etc. Supporting documentation must be in the name of the requester, and if a bill please make sure it shows your name, the name of the company, and the amount. It should be clear from viewing, who the bill is from, who it is to, and what is owed. By submitting this form you acknowledge that applications will not be considered without documentation.

Please acknowledge this requirement

Please select the category of funding for which you are applying

Housing: Past due rent or mortgage payment OR reimbursement for emergency housing at a hotel

Utilities: Past due utilities bill(s)

Child care: Assistance with childcare in order to attend courses

Transportation: Vehicle repair OR public transportation assistance in order to attend courses

Grocery card

Due to limited funding available, partial awards may be provided to approved applicants. The amount requested must be supported by documentation. Think of your supporting documentation as a 'receipt' that shows exactly what amount you are requesting support to cover. For example, if you are requesting $250, your attached supporting documentation must show itemized costs for that amount.

If awarded, how will these funds support your ability to continue your education at College of the Canyons?

Please list your major/certificate objective

Do you have a completed Comprehensive Student Education Plan on file?

Yes

Have you applied for CalFresh (SNAP) monthly food benefits and/or general relief?

Yes

Please tell us if any of these apply to your current situation

I am homeless

I do not have a permanent place to stay

I am experiencing difficulty obtaining enough food for myself and/or my family

I have expenses I am currently unsure how I will cover

I do not have the resources I need to take my classes (textbooks, lab fees, supplies, internet)

I am currently in an unsafe living situation

None of the above

Please tell us what resources are currently available to you

Income from a job

Income from other sources

Potential for loans from my family

Place to stay with family or friends

Financial aid or scholarships

Public benefits or assistance

Veterans benefits or assistance

None of the above

By submitting this application, I attest that the information I have provided is true and accurate, to the best of my knowledge. Should I receive emergency aid, I agree to make a good-faith effort to maintain my attendance during the semester and make progress toward the completion of my degree/certificate. Additionally, I acknowledge and accept the potential impact receiving these emergency aid funds may have on my future financial aid allocation(s). Any questions regarding the potential impact receiving such an award may have on future aid allocations may be directed to the Financial Aid office.

Please acknowledge this requirement

Supporting Documentation

One file only.
15 MB limit.
Allowed types: gif jpg jpeg png pdf doc docx.