Student Emergency Fund - Funding Approval Form - Mental Health and Wellness - Wellness - Current Students

Please complete the following form to allow for processing of funding approved financial assistance through the Student Emergency Fund

Name*
First Last
Student Number*
Carleton Email*
Type of Study*
- Undergraduate
- Graduate
Study Type*
- International
- Exchange
- Domestic
Permanent Address (for funding to be sent to)*
Street Address Address Line 2 City Province Postal Code
Receipts and Expenditures
Please attach copies of receipts (electronic scans are satisfactory) for expenditures requested. Pleas 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 will update The Office of Student Affairs 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.

Student Emergency Fund – Funding Approval Form