Acts of Kindness Application

Fields marked with an asterisk "*" are required.

Student Information

Student Name:*  
Student ID Number:*  
DOB:*  
Street Address:*  
City, State, Zip:* ,      
Email:*    
Phone:*  
Number of dependents
(including yourself):*
 
Marital Status:
 
Race/Ethnicity (select one or more):





Are you a single parent?  
Your current employment status
 
Are you a U.S. veteran?  
Were you in foster care at the time you turned 18?  

Education Profile

Is this your first semester at IHCC?  
Cumulative GPA
Number of credits earned to date
Credits in current term
Program of Study    
Expected graduation date

What are your plans as they relate to your future educational goals and aspirations at this college?
 

Financial Profile

Have you received emergency funds through IHCC before?  
Have you completed the Free Application for Federal Student Aid (FAFSA) for this academic year?
Are you receiving:




How did you learn about AoK emergency funds program?

 
In your own words, please describe why you are requesting emergency aid:
 
How does this emergency affect your ability to complete this semester of college or continue with your education at Inver Hills Community College?
 
Please indicate if any of these apply to your current experience:





Please identify what resources are currently available to you:






What other resources have you explored for assistance to resolve your current emergency?
What is the amount of emergency aid that you feel you need to resolve your current emergency?
(Students may request up to $1000 per semester with a lifetime limit of $2000)
Housing/Rent $
Automobile Expenses $
Gas $
Public Transportation/ Bus Pass $
Food/Meals $
Utilities $
Child-related $
Health/Medical-related $
Other (if other, describe) $
Total $
Is there anything else you think we need to know in order to make a determination if you will get an emergency grant?

READ BEFORE PROCEEDING

* By submitting this document, I commit to using the emergency assistance grant award for its intended purposes, outlined in this application. I will not use the emergency assistance grant award to pay for tuition or books. I also agree for college staff and/or staff from the MN Office of Higher Education to contact me to follow up on my progress after the application is submitted. I verify that all information provided in this application is true and verifiable.  

Date:*

Counselor:*