Emergency Student Assistance Application

The Emergency Student Assistance Fund is designed to give you a helping hand when life throws unexpected challenges your way. By providing support for one-time, unforeseen expenses, this fund helps you stay focused, continue your studies, and keep moving forward on your path to success at Athens State University. Please read the instructions carefully and complete all sections of the form.

Guidelines for requests:
• Only emergency, one-time expenses from your current term are eligible.
• You must provide documentation (such as a past-due bill, car or home repair invoice, medical bill, or childcare bill) to support your request. Requests submitted without documentation are considered incomplete and may delay processing.
• Include the exact amount you are requesting. Requests without a specified amount are considered incomplete and may delay processing.

Name

First Last

Athens State Email (@my.athens.edu)

What is your Athens State Student ID number?*

Have you applied for financial aid at Athens State University through the FAFSA?*

YES
NO

Are you currently employed?*

YES
NO

If yes, list your average hours per week

Do you currently owe Athens State University money?*

YES
NO

Have you received emergency assistance from the ESA Fund before?*

YES
NO

What dollar amount of emergency assistance are you seeking?

In your own words, briefly explain your situation and how this unexpected emergency will prevent you from completing your courses this semester.*

If approved, I would like my funds disbursed via:*

A check mailed to me
A check I pick up in person on the main campus

Emergency Student Assistance Application

ESA Application

Step 1 of 3 – Important Information