Student Emergency Fund

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CELL PHONE NUMBER (REQUIRED):

Date of Request(Required):

This field is required.

How did you hear about funding:

Applicant Information

Please complete this information as completely as possible.

Your full name

Lehigh ID Number

Cell Phone number

Lehigh Email address

Information concerning request

Please provide the written explanation of the nature of your request. If this request is a result of an emergency situation, please provide a summary of the situation and when it occurred.(Required) This field is required.

Amount Requested(Required) This field is required.

Are you requesting a loaner laptop for academic use?(Required) This field is required.

If you answered Yes, what type of laptop is needed? This field is required.

If you selected Apple (Mac), please give a brief description as to why you need this type of machine. This field is required.

Date that funds are needed by (please format date as YYYY-MM-DD)(Required) This field is required.

Supporting Documentation

Documentation of the cost. If you have already incurred the expense, please provide documentation of the costs (i.e. Receipt from purchase, medical bills, etc.). If you have not yet incurred the expense, please provide us with as much documentation that you have available to support the amount that you are requesting (i.e. Estimate of the cost, bill, etc.). 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Applicant Information

Information concerning request

Supporting Documentation

Submission