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Student Emergency Fund Support Request

Personal Information

Contact Information

Mailing Address

Province

Residence Address (if applicable)

Student Information

Have you applied to receive funding through the Student Emergency Fund in the past?
Have you received funding through the Student Emergency Fund in the past?
Request Information

Budget Statement

Once your application for the Student Emergency Fund has been received by Student Development and Services and reviewed by a Student Success Coordinator, you may need to provide an additional budget statement highlighting income sources and expenses in addition to having a discussion with a Student Success Coordinator.
Protection of Privacy
The personal information on this form is collected under the authority of the Nipissing University Act, 1992. It is related directly to and needed by the University to provide services to students in the course of their studies while at Nipissing University. If you have any questions or concerns about the collection, use and disclosure of this information please contact Student Development and Services at Nipissing University, 100 College Drive, North Bay ON, P1B 8L7, (705) 474-3450 ext. 4493.