CARES Act: Phase 1

Higher Education Emergency Relief Fund (HEERF)
CARES Act: Student Certification Form - Phase 1
Congress established the Higher Education Emergency Relief Fund (HEERF) as a part of the Coronavirus Aid Relief and Economic Security (CARES) Act. The fund provides grants to institutions of higher education to assist students with emergency financial aid grants for expenses related to the disruption of campus operations due to coronavirus. The fund may assist students with eligible expenses related to their cost of attendance such as food, housing, course materials, technology, health care and childcare.

* = Required Field
Have you been affected by the COVID-19 pandemic?
Please check one:*
- Yes
- No
If yes, please certify below: I,
Your name*
, certify that I have been affected by COVID-19 and therefore agree to use the funds distributed to me for the following needs: food, housing, course materials, technology, health-care and/or childcare expenses as stipulated in the CARES HEERF Policy set forth by the US Department of Education.

These funds will not be used for tuition expenses or paying off tuition balances.
Please check one:*
- I would like to pick up my check
- I would like my check mailed
If applicable, please mail my check to:
Street Address
City, State, Zip
Student Signature*
Student ID (5 digits)*
This field is hidden when viewing the form
Date
MM slash DD slash YYYY
For School Use ONLY

__________________________________________________________________
School Official Signature

________________________________
Date

74466

CARES Act: Phase 1

Higher Education Emergency Relief Fund (HEERF) CARES Act: Student Certification Form - Phase 1

For School Use ONLY

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Higher Education Emergency Relief Fund (HEERF)
CARES Act: Student Certification Form - Phase 1