Cal Poly Cares Application For Assistance 2020-2021

Cal Poly Cares provides emergency grants to students experiencing unexpected expenses which are impacting their ability to be successful.

Information About You

Empl ID *

Enter any leading zeros, must be 9 digits

First Name *

Middle Name

Last Name *

Cal Poly Username *

Phone Number *

College *

Major *

Class Standing *

How many units are you currently enrolled in?

Have you applied for Cal Poly Cares in the past?

Yes

Cal Poly Cares Awards

Have you been impacted by loss of wages?

Yes

How many hours do you typically work per week? *

What is your hourly wage? *

Please share an approximation of your wages lost. *

Please share how you utilize your wages. *

Where was your place of employment? *

What is the reason for your loss of employment? (Please select all that apply) *

Place of employment operating remotely	Moved out of the area due to pandemic	Medical reasons	Family reasons	Other
Place of employment reduced my hours

Please explain how these unexpected circumstances may affect your ability to remain enrolled at Cal Poly.

Explanation of circumstances *

Housing *

Yes

Type of housing requesting *

Off-Campus

On-Campus

Do you have an emotional support animal? *

Yes

Do you have a parking pass? *

Yes

Dollar amount requested * $

Describe why you need housing. Please provide a detailed breakdown of how you plan to spend the funds you are requesting. *

Provide Housing documentation

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf doc docx xls xlsx.

Medical *

Yes

Provide medical receipts/quote *

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf doc docx xls xlsx.

Dollar amount requested * $

Describe why you need support for medical expenses. Please provide a detailed breakdown of how you plan to spend the funds you are requesting. *

Academic Supplies and Materials *

Yes

Supply receipts/quotes

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf doc docx xls xlsx.

Dollar amount requested * $

Describe why you need academic supplies and materials. Please provide a detailed breakdown of how you plan to spend the funds you are requesting. *

Tuition (not eligible for Federal Care Act funding) *

Yes

Dollar amount requested * $

Describe why you need tuition assistance. Please provide a detailed breakdown of how you plan to spend the funds you are requesting. *

Commencement Regalia *

Yes

Describe why you need assistance with commencement regalia *

Other *

Yes

Dollar amount requested * $

Describe your need *

Please add up the total dollar amount you have requested and enter it below

Enter the total amount requested * $

Additional Information

Have you been impacted by the wildfires in California? *

Yes

Explanation of circumstances *

Are you a graduating senior? *

Yes

Are you currently receiving financial aid? *

Yes

Have you met with a financial aid counselor?

Yes

What was the outcome? *

Are you currently employed? *

Yes

Do you work on or off campus? *

On-Campus

Off-Campus

Are you currently seeking employment? *

Yes

Are you enrolled and receiving meal vouchers through the Dean of Students Office? *

Yes

Are you in the Multicultural Engineering Program? *

Yes

How were you referred to Cal Poly Cares? (Please select all that apply) *

Faculty/Staff	Office of the Registrar	Health Services	Housing	Friend
Academic Advisor	Counseling Services	Basic Needs	Website	Other
Financial Aid Office

Add additional documents

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png html pdf doc xls xlsx.

Is the amount you are requesting expenses directly related to the disruption of campus operations due to coronavirus, such as food, housing, course materials, technology, health care, and child-care expenses? *

Yes

To be eligible for federal Cares Act Emergency Grant funds please confirm the following (select all that apply): *

I am a U.S. Citizen or eligible permanent resident	I am registered with selective service or female at birth	I am not in default of a federal student loan	I have a minimum 2.0 GPA	One or more of these doesn’t apply to me, please consider me for Non-federal funding
I have a valid social security number

By checking below, I give permission to apply Cal Poly Cares grant to charges that are not automatically paid by financial aid, including, but not limited to housing and dining fees, health fees, etc. Granting this permission may expedite the clearing of charges on your student account, thereby helping you avoid late payment fees and/or a hold being placed on your student records.

Permission to Apply Charges? *

Yes, I give permission

By checking below, I give permission to the Cal Poly Financial Aid Office to release my financial aid award information to the members of the selection committee. If you do not give this permission, your application cannot be processed. For additional questions, please call Student Support, Success and Retention at 805-756-2472.

Permission to Financial Aid? *

Yes, I give permission

Please Confirm Your Cal Poly Email *

Leave this field blank

Cal Poly Cares - Forms

Web Forms for the Cal Poly Cares Program

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