Emergency Funds Request
The Student Success Fund assists Chemeketa students in continuing their education in case of a financial emergency or unforeseen expense causing financial hardship.
First and Last Name *
Your answer
K Number *
Your answer
Chemeketa Email Address *
Your answer
Phone *
Your answer
Check all that you are currently enrolled in *
Chemeketa Classes
GED
ESL
SNAP (Anyone in Household)
TANF (Anyone in Household)
Financial Aid
Eligibility
Check all that you are currently enrolled in
TRIO
CCP
HEP
CAMP
STEP WorkSource Oregon
STEPS Student Parents
Programs
Amount Requested *
Your answer
Term Requested *
Summer
Fall
Winter
Spring
Term
Which degree are you pursuing? *
AAOT
AGS
AAS
Certificate
Degrees
Anticipated Graduation Year and Term *
Your answer
Please explain the need for support. *
Your answer
Please explain the situation that led to this unforeseen expense: *
Your answer
What steps have you taken or plan to take to prevent this unforeseen expense in the future? *
Your answer
Have you met with anyone else at Chemeketa regarding this need? If so, who have you met with? *
Your answer
Are you receiving funding from any other office in relation to this situation? If yes, please explain. *
Your answer
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