LGBTQ+ Program Participant Student Relief Fund Application

Central Oregon Community College offers the LGBTQ+ Program Participant (LPP) Student Relief Fund to support students with financial challenges related to their educational costs. Important notes:

Students must be currently enrolled in a minimum of 1 credit at COCC and participate in the LGBTQ+ and Friends Club or related events/programs.
Students may submit one request per term.
Students who receive COCC Student Relief Fund support are also eligible for the LPP Student Relief Fund.
COCC reviews applications when received and notifies students of the decision via their COCC email account. If approved, applicants will be contacted to arrange fund disbursal.
Funds are limited and based on availability.
There is a $500 max award amount.

Step 1. Describe Your Emergency: Please select one or more categories that best describes your emergency.

Vehicle Repair/Transportation

Eviction/Housing

Utility Shut Off/Past Due Notice

Childcare Expenses

Loss of aid and near program completion

Technology

Medical/Dental Expenses

Other:

If 'Other' was selected, please specify:

Please briefly explain your emergency:*

Step 2. Urgency: To determine the urgency of your financial emergency, check all boxes that apply:

I am at risk of withdrawing from all courses

I am at risk of failing

I need reimbursement for costs already paid

I am currently unable to attend my courses

Other:

If 'Other' was selected, please specify:

Step 3. How you will use funds: Please describe how you plan to use these emergency funds. Include the amount you are requesting. Provide as much detail as possible.*

Step 4. COCC Involvement: Eligibility requires current or past involvement. Please share what LGBTQ+ cultural programs you are currently participating in. If you participated in the past, how do you plan to stay connected to the LGBTQ+ cultural programs now or in the future? This can include going to Club meetings, events, meeting or connecting with staff, volunteering, etc.*

Step 5: Contact Information

Student Name*

Student ID Number*

COCC Email Address:*

Date*

By checking this box, I certify that the information in this form is true.

Yes

Staff reviewing applications may request further information as needed to determine award options.

Questions? Contact Christy Walker (cwalker2@cocc.edu)