Housing Assistance Request
Hello! Please fill out this form to request housing assistance from Secure the Student. You may request up to $500. Once received, we will be in touch as soon as possible. Please be prepared to submit documentation (i.e. your lease) that states your name and housing cost. We look forward to assisting you!

*If you are unhoused or in transitional housing, please email us at hello@securethestudent.org.
Name *
Date of birth *
Gender *
Ethnicity *
College email address (please refrain from using personal email address) *
Phone number *
Address *
School *
Grade point average *
Graduation year *
Are you unhoused or in transitional housing? *
Please check beside your source(s) of income (employment paystubs will be requested) *
Required
Please check beside other programs you participate in *
Required
Amount request (proof of amount needed will be requested) *
Date the request is needed by *
How many roommates do you have? *
How did you hear about Secure the Student? *
I understand that Secure the Student has the right to deny, partially, or fully grant my request. *
I understand that I must be an enrolled, undergraduate student at a community college or 4-year institution in Virginia. *
Submit
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