MIAD Student Emergency Fund Application Mar 24, 2020 MIAD Emergency Fund Application MIAD’s Emergency Fund is designed to provide financial support to MIAD students who are experiencing financial hardship. Upon review of your Emergency Fund Application, MIAD may contact you for additional documentation. Student Name*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code * this is where a check would be mailed.Email* Home PhoneCell PhoneI am asking for the following amount from the Emergency Fund.*Please enter a number from 0 to 200.($200 maximum)Description of Hardship* Job loss Student employment (e.g. proof of unemployment) Job loss of family member (e.g. proof of unemployment) Unusual uninsured medical expenses caused by severe illness or accident (e.g. copy of medical bills) Death in the family (e.g. obituary or death certificate) Loss of primary residence, unable to make rent payment (e.g. eviction/foreclosure notice) Other (explain below) Check all that apply. Please provide suggested supporting documents, if available.Explanation of HardshipPlease provide more detailed information of your financial hardship.Supporting Documents Drop files here or Accepted file types: jpg, png, pdf, tif. Upload any supporting documents here.Consent* I have read and understand the provisions of MIAD’s Emergency Fund. I understand that submission of this application does not guarantee approval. I hereby authorize the appropriate individuals to review my student academic and financial record.