Electronic Application for Student Veterans Emergency Fund

Name Name First Last
CWID
Local Address Local Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Mailing Address (if different from local) Mailing Address (if different from local)
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
OSU College/School
Academic Advisor
Phone Phone - ### - ### ####
Email
Major/Program
Student Classification
Cumulative GPA
Essay - Explain why you need financial assistance and how this assistance will help you to succeed academically.
Maximum of 500 words allowed. Currently Entered: 0 words.
Provide current monthly budget including all income as well as educational/disability benefits currently being received. (For example: Job wages - $xxx.xx, VA Disability - $xxxx.xx, BAH $xxxx.xx, etc.)
Current expenses as of the date of this application. (For example: Electricity - $xxx.xx, Child care $xxx.xx/wk, Rent - $xxx.xx, Car Payment $xxx.xx, Insurance $xxx.xx etc.)
Total Amount Requested:
Required Documentation:
1) Bank Statements for last 60 days 2) Utility and other bills for last 60 days 3) Child Care, car payments, insurance, medical, loans, credit cards, or other billing statements 4) Any other documentation that shows need for assistance (i.e. eviction notices, over-draft notices, etc.) 5) Proof of military service that shows honorable or general under honorable conditions discharge rating (DD214, VA Letter, etc)
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I confirm the accuracy of this information and wish to apply for emergency financial assistance through the Student Veterans Emergency Fund.

I confirm the accuracy of this information and wish to apply for emergency financial assistance through the Student Veterans Emergency Fund. Yes
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Date Date / MM / DD YYYY