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. Δ