UMGSA: 2019 Holiday Hamper Application
UMGSA: 2019 Holiday Hamper Program
Name *
Student number *
Student email *
Department *
Program *
Phone number *
How many people, including you, are in your household? *
What is the main source of income in your household (e.g.: funding from your program, wage from another job, wage from your partner's job, savings, etc.)? *
In a typical month, how difficult is it for you to cover your expenses and pay all your bills? *
Not all difficult
Extremely difficult
Are you struggling to pay off debt such as personal loans, student loans or credit card debts? *
Is your mental health being affected by your current financial situation? *
In the last 12 months, have you personally gone without food to eat? *
In the last 12 months, have you personally gone without needed medicine? *
In the last 12 months, have you personally had trouble paying your rent? *
In the last 12 months, have you personally made sacrifices to your leisure time in order to keep your finances balanced? *
In the last 12 months, have you personally made sacrifices to clothing in order to keep your finances balanced? *
How do you think this Holiday Hamper would help you? (Max. 300 words) *
Declaration: I affirm that the information and statements contained in this document are true. *
Required
Name *
Date *
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