Financial Hardship Application - Prairie State College Workforce Equity Initiative

Step 1 of 2: Submit

Thank you for considering our WEI Grant Financial Hardship application. We want to assist you as much as possible. You must be a WEI Grant recipient, currently taking taking classes or recently (within 2 semesters) have successfully completed a WEI Grant eligible class or program. We will follow up with you in 2-3 days.

Student ID Number: Date:

Last Name: First Name: Middle Name: Date of Birth:

Home Address: Apt. Number: City: State: Zip Code: Home Phone: Work Phone: Email Address: Other Contact:

Please answer all the following questions:

Employment Status: If Unemployed, how long? Number of family members living in the household: Housing Status: Monthly Payment: Student Monthly Salary (Gross): Student Other Income (Alimony, etc.): Student Subtotal: Spouse Subtotal: Total Family Income:

Explain why you are requesting financial support due to financial hardship:

Please submit TWO of the following documents: Copy of unpaid bill, invoice, or eviction notice (with your name included) Copy of daycare, utility (gas/electric) or phone bill (with your name included) Verification of payment/receipt (with your name included) Copy of contact info for entity requesting payment (with your name included)

Supporting Documentation

I hereby certify that no other source, welfare program, parent or other person or program is legally responsible for my bills. I certify that the information on this form and supporting documentation is true and correct. I authorize Prairie State College, Workforce Equity Initiative to verify any information contained in this document for the sole purpose of assessing financial need.

Applicant Signature:

Date: Wednesday, 24 April 2024 (EDT)

Name:

Type your name to sign this document:

Typing name is equivalent to a handwritten signature

Scan this QR code with your phone:

Date: