BCCS Emergency Relief Fund Application
You may use this form to apply for a $150 Visa gift card from BCCS' emergency relief fund. The fund was created to support BCCS community members facing financial hardship as a result of the COVID-19 crisis. One application per family is allowed.
Applicant's First Name *
Your answer
Applicant's Last Name *
Your answer
What is your (the applicant's) affiliation to BCCS? *
If you are an alumnus, what is your year of BCCS graduation?
Your answer
If you are a parent, what is your student's name?
Your answer
Street Address of Applicant *
Your answer
Address Line 2 (e.g. Apt. Number)
Your answer
City *
Your answer
ZIP Code *
Your answer
Applicant's Phone Number *
Your answer
Applicant's Email Address *
Your answer
Are you completing this form on behalf of someone else?
If yes, what is your name and how may we contact you?
Your answer
Submit
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