Student Emergency Support Fund

First Name*

Last Name*

LSU Student ID (89-xxx-xxxx)*

Current Street Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Phone*

LSU Email Address*

Must be a valid LSU email address.

Academic College

How did you hear about the Student Emergency Support Fund?*

Please answer the following questions to help us understand your situation.

Do you have housing?*

Yes, temporary Yes, long term No

Are you currently employed?

Yes No

If you answered Yes above, where do you work and how many hours a week?

Do you currently receive financial aid or a scholarship?**

Yes No

*If you currently receive financial aid, please be aware that receiving funds from the Student Emergency Support Fund could impact your current aid package. It is your responsibility to communicate with Financial Aid & Scholarships regarding the potential impact.

If you answered Yes above, please list.

Are you an international student?***

Yes No

**Cash awards to international students are automatically taxed at 14-30% depending on their visa type. Please check with the LSU Office of International Services at isograd@lsu.edu for guidance.

What specific life event occurred that prompted your request for emergency support funds?*

Please provide as much information as possible.

Please indicate your requested amount of funding.*

The maximum amount of this award is $750.

If you have a need for more than $750 in funding, will you allow our office to share the information on your application and supporting documents with other units at LSU?*

Yes No

Please note there is no guarantee that additional funding will be available. Determinations will be made on a case-by-case basis.

Please describe how you would use funds from the Student Emergency Support Fund, including specific items and amounts.*

Explain how these unexpected expenses could affect your ability to remain enrolled at LSU.*

Please describe your efforts to obtain assistance for these unexpected expenses through other sources (family, friends, campus/community organizations, etc.). List aid that has already been provided.*

Please include anything else you feel relevant as the committee considers your application.

Email appropriate documentation relating to your situation to Molly McCann at mmccann@lsu.edu.

These items can include:

emergency medical bills
estimates for repairs
photos
letters of support
email correspondence related to the emergency
financial information
expert evaluations
police/fire reports
other accident reports

Documentation*

I have the documentation now and will email it to Molly I need additional time to pull my documentation together, but will send at least something to Molly within 24 hours of this application

Certify*

By adding my e-signature below, I authorize LSU Student Affairs to evaluate my financial aid information.

Signature of Applicant*

Please type in your full name as signature.

I authorize that all information provided on this application, including any and all personal, financial, and other data may be shared with the LSU Division of Student Affairs, LSU Family Council, LSU Office of Financial Aid & Scholarships, and the LSU CARE Team. This data will be securely retained indefinitely. To learn more about privacy at LSU, please see the LSU Privacy Statement.

Data Consent*

I authorize