To apply for this grant fill out the form below. Following your submission, the committee will review your application and inform you of a decision as soon as possible. Please note that, in most cases, the committee will contact you to request supporting documentation before a decision is made.

This committee may include staff from Student Life, Student Health, Counseling and Psychological Services, Graduate Division, Office of International Students and Scholars, Office of Financial Aid and Scholarships, as well as graduate student representatives. If you have concerns about sharing personally sensitive information with graduate student members of this committee or any questions about the process, please contact committee member and Graduate Academic Counselor, Ryan Sims, with your concerns at

Please complete all the sections below. We are unable to process incomplete applications.
Email address *
Please type in your Name *
Help us understand the nature of your emergency. You can check more than one box. *
Is your financial hardship the result of COVID19?
Clear selection
What is your home department? *
What is your Perm. number? *
What is the best telephone number for you? *
Mailing Address *
Are you a currently enrolled graduate student? *
Are you a domestic or international graduate student? This information helps the committee guide you to other resources. *
Personal Statement. Enter or paste-in a statement. 500 or fewer words, please. Describe the nature of your emergency and what you have done to address the situation so far. Also, explain how you foresee resolving the situation. If you feel uncomfortable about sharing sensitive information here, please indicate that. A professional staff member from the committee will contact you to discuss your situation. *
Grant Amount Requested. Please note that the maximum grant amount is $1,000. *
Income: Describe what sources of income you have or will have, including jobs, financial aid, family support, gifts, etc. Why are these funds insufficient to cover the current emergency expense? *
Savings/Investment: Do you have any savings or investments? If so, please describe and include dollar amount or valuation. Can you help us understand why these cannot be used to cover this emergency? *
Dependents Supported: If you support dependents, how many?
Other Sources: What other support options have you pursued (either on or off campus; can include loans, family loans, food banks, CalFresh, etc.)? *
Have you filled out the FAFSA for the current academic year? This information is used to determine if there are other sources of assistance that can be provided. You are not required to fill out the FAFSA for this grant. *
Additional Support: Would you be interested in a referral to other campus services, as appropriate? *
Time Frame: Given your current situation and options, how soon do you feel you need to receive an Emergency Relief Grant? *
If you receive the grant, a check will be mailed to the address you provided on this form. Is this okay? *
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy