Student Emergency Fund – Funding Approval Form

Please complete the following form to process your approved financial assistance through the Student Emergency Fund. Please attach copies of receipts (electronics scans are satisfactory) for expenditures as requested. *Please note ONLY approved totals will be reimbursed.

Name*
First Last
Student Number*
Carleton Email*
Study Level*
- Undergraduate
- Graduate
Study Type*
- International
- Exchange
- Domestic
Permanent Address*
Street Address Address Line 2 City Province Postal Code
How would you like to receive your funds?*
Sometimes students have direct deposit enabled with the university. If we find that you have an account on file, would you prefer that your funds be released electronically?*
Receipts and Expenditures (if requested)
Max. file size: 20 MB.

Please attach copies of receipts (electronic scans are satisfactory) for expenditures requested. Please note this field is ONLY required if it was listed as a condition for funding support. Please note ONLY approved totals will be reimbursed.
Acknowledgement*
I acknowledge that the above information is accurate and that I will update the Student Emergency Fund Team should any changes occur after the initial funding approval has taken place.
The information in this message, including all attachments, is privileged and may contain confidential information intended only for the person(s) named above. Any other distribution, copying or disclosure is strictly prohibited. If you are not the intended recipient or have received this message in error, please notify Carleton University immediately by reply email at the contact listed above and permanently delete the original transmission from us, including any attachments, without making a copy. Carleton University is fully compliant with the Freedom of Information and Protection of Privacy Act and appreciates your cooperation in this matter.

Mental Health and Wellness

Student Emergency Fund – Funding Approval Form

Student Emergency Fund – Funding Approval Form