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Home
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Student Support
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Emergency Fund Application
Emergency Fund Application
If you see this don't fill out this input box.
Student's Full Name
*
Enter Your Full Name
Complete Mailing Address (current, include house or apt #, street, city, state, zip
*
Enter Your Full Mailing Address
Preferred Email Address
*
Enter Your Email Address
Current Phone Number
*
Enter Your Phone Number
Which campus to you attend?
Malone Campus
Saranac Lake Campus
Ticonderoga Campus
Online
Extension site
Select the campus location you attend most of your classes
Are you employed?
Employed full-time
Employed part-time
Currently unemployed
Select your employment status
Do you have any dependents?
Yes I have dependents
No I have no dependents
I prefer not to respond
Select One
Please select the reason(s) you need this emergency funding support:
Utilities
Rent/Housing
Food/Meals
Personal Hygiene Items
Transportation/Auto Expenses (gas, repairs, auto payment)
Childcare Expenses
Medical Expenses (physician, dental, eye, mental health, etc),
Select All That Apply
Please explain your needs in greater detail so the review committee has a better understanding of your most immediate needs. Please note, copies of a budget plan or invoices may be required to complete the review of your request.
*
Describe Your Request In Detail
Enter the amount of your request for emergency financial assistance:
*
Our funding capacity is limited currently. Requests over $50 may take longer to approve. Maximum amount you may request is $500.
Your Monthly Budget
Please itemize your typical budget including monthly bills with amounts
If requesting grocery or gas assistance, please select what type of gift card would be most preferable to you. (Available in $50 increments)
Hannaford
Pricechopper
Tops
Wal-Mart
Gas Station (various)
Select Type of Gift Card (if applicable)
I understand that I am eligible for each type of emergency funding only once while in attendance at North Country Community College. Once approved, I will NO longer be eligible for the same emergency fund request. If approved for a Ragusa Loan, I understand that if for any reason the approved financial aid funds are insufficient to cover tuition, fees, books, and this emergency loan, I am fully liable for repayment. (Note, for students who fail to repay the Ragusa Loan, a “HOLD” will be placed on all records at North Country Community College. Loans not collected will be turned over to a collection agency and applicants will be liable for the cost of collection in addition to the unpaid balance and lose eligibility for all other emergency funding sources at the college.)
*
Enter Your Student ID Number to Sign Your Application
Submit
Clear
Last Updated 9/9/20
Last Updated