HEERF III Student Emergency Grant Application

Legal Name:*
First Last
Preferred Name:
Email:*
Phone Number:*
Total Amount of Funds Requested:*
Please specify the needs for which you are requesting the grant and identify the expense for each item.*
Please share any additional information that may be helpful in assessing your request.*
Date:*
MM slash DD slash YYYY
Signature:*
Consent*
By clicking "Submit" I certify that the information I have provided is true and complete. I will notify the Dean of Students in writing immediately if there is any subsequent change to the information provided.

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Name*
Phone*
Email*
Program Of Interest*
Consent
By checking this box, I agree that Starr King School for The Ministry may call and/or text me occasionally about educational programs and events at the phone number provided. You may opt-out at any time.
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Phone
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