Student Crisis Fund Request

Applicant Information

Please complete the necessary information to process your request.

If tuition-related, have you contacted Financial Aid?

Yes
No -- see instructions, below
Not tuition-related

If no, contact Donald Vince, Associate Director of Admission and Financial Aid at 937-229-3568 or dvince1@udayton.edu.

Full Name:

Mailing Address:

Email Address:

Class Year:

Phone:

Student ID Number:

Funds Requested:

Choose from the following:

Medical Emergency
Unexpected Travel
Financial Hardship for Basic Essentials
Other

Please explain your situation: (all circumstances will be kept confidential)

What other resources have you contacted for help with your financial needs?

List the approximate amount and source of any financial help you are currently receiving:

* Please check the box and electronically sign below:

I acknowledge that all the information I have provided, verbally and in writing related to my request for assistance is true. I understand that a committee will review my request for assistance and make a final decision to approve or reject my request.

Signature:

Date:

Please solve this simple math equation to prove you are human and to help fight SPAM.

*4 plus zero =

University of Dayton, Ohio

Student Development

Student Crisis Fund Request

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