CCC&TI CARES Act Funding Student Application

1. CARES Act
Emergency Funds Application
Student Name Student ID Phone Number
Caldwell Community College and Technical Institute is committed to helping our students affected by the
current COVID-19 crisis. The CARES Act emergency funds application process is available to assist eligible
students facing financial hardship as a result of the COVID-19 national crisis. If you are experiencing financial
hardship as a result of COVID-19, complete, sign, and submit this CARES Act Emergency Funds Application.
Assistance provided as a result of this application, will be distributed as quickly as possible. Distributions will
be mailed to the address on file as a paper check. Confirm your mailing address below:
Mailing Address City State Zip Code
Select the reason for requesting emergency assistance:
□ Job Loss as a result of the COVID-19 National Emergency
□ Temporary furlough as a result of the COVID-19 National Emergency
□ Medical issues as a result of the COVID-19 National Emergency
□ Other hardship related to the COVID-19 National Emergency
Select the purpose of requesting COVID-19 emergency funds assistance:
□ Housing
□ Food
□ Utility
□ Technology
□ Medical
□ Transportation
□ Dependent Care
I am requesting funds due to financial hardship as a result of the COVID-19 National Emergency. I have been
negatively affected financially by COVID-19 and will use these funds for emergency expenses.
Student Signature Date
Caldwell Community College and Technical Institute

2. 2855 Hickory Blvd.
Hudson, NC 28638
828.726.2713