Finish Line

Finish%20Line -

Application

Emergency Assistance Application

The Finish Line Grant program helps students complete their education when facing unforeseen challenges. To be eligible, students must have completed at least 50 percent of their credit or noncredit program and be in good academic standing. This grant provides a maximum of $1,000 in assistance per semester, for qualified expenses.

First Name:

Last Name:

Name you go by (if different from above):

Durham Tech ID:

Don’t Have or Know participant ID Number

Please use your 7-digit Durham Tech Student ID number

Have you completed at least 50% of your academic program?

Last 4 Digits of your SSN:

Primary Address:

Street		City
State		Zip
County

Email:

Phone:

Are your currently receiving financial aid?

As of today, how many adults live with you and are related to you by blood/marriage/decree-of-court? Do not count yourself.

As of today, how many children under the age of 18 live with you and are related to you by blood/marriage/decree-of-court? Do not count yourself.

Have you ever received assistance through the Finish Line Grant?

What is your household's annual income? $

Employment Status

Please select the emergency(ies) from the list below:

Rent

Car Repairs

Utility

Medical Expense

Tuition/Course Materials/Fees

Internet Service

Briefly explain your emergency and how this will impact your ability to continue with your training:

Payments Requested

What are you requesting support for? (Note: Finish Line Grants provide a maximum of $1,000 per semester for eligible expenses.)

#	Purpose What is the purpose of the payment?	Vendor Who is the payment made to?	Amount	Account Info if applicable
Ex.	Utilities - Natural Gas	Dominion Energy	$130.33	Acct #1234567891011
#1			$
#2			$
#3			$
#4			$

Signature

I certify that the information on this request for assistance is accurate to the best of my knowledge. I understand that my willful misstatement of the facts may cause my forfeiture of any assistance. I hereby approve the release of all information that is determined pertinent to my request, including but not limited to phone number, financial information, class schedules and grades, disability determination, and any other related information that would result in assistance with my request. I hereby acknowledge that this consent is voluntary.

Signature of Student/Participant

Please enter your full name and birthdate

Signature Date

[ 4/20/2024 ]

Sun	Mon	Tue	Wed	Thu	Fri	Sat