Skip to main content

CARES Fund Distribution: Appendix A Student Response Form

Students who do not have a balance receive the following form:

You are eligible for $1,200 in CARES funds associated with additional expenses due to COVID-19. Please submit answers to the questions below to receive those funds.

  1. Please identify the types of additional expenses you have experienced due to the COVID-19 pandemic. (Check all that apply)

    □ Academic expenses
    □ Housing
    □ Medical
    □ Food
    □ Technology
    □ Transportation
    □ Childcare Expenses
    □ Utilities
    □ Other: Please specify ________________________________________________

  2. Update your information by entering your bank routing number, bank account number, and mailing address below. The CARES funds will be disbursed via direct deposit if you provide accurate and updated banking information. If you do not provide banking information, funds will be disbursed via a check to the address you provide.

    Routing Number: __________________________
    Account Number: __________________________
    Address Line 1: ____________________________
    Address Line 2: ____________________________
    City: _____________________________________
    State: ____________________________________
    Zip Code: _________________________________

□ I certify that this information is accurate, and understand that my CARES funds may be delayed if I submit invalid information.

By submitting this form, you affirm that you understand that you are requesting funds, the award of which is based upon the accuracy of information you have provided, and you certify all information is true and correct to the best of your knowledge.

Students who have a balance will receive the following:

You are eligible for $xxxx in CARES funds associated with the COVID-19 pandemic.

  1. Would you like to apply the CARES funds to your Eastern Kentucky University Account Balance of $YYYY, with the remaining balance refunded to you?
    • Yes (Skip to Q3)
    • No
  2. Acknowledgement: I acknowledge that I owe $YYYY on my student account balance and if unpaid that balance prevents me from re-enrolling in future terms.
    • Yes, please apply ______ (0 to $YYYY) of the CARES funds to my student account balance.
  3. Please identify the types of additional expenses you have experienced due to the COVID-19 pandemic. (Check all that apply)

    □ Academic expenses
    □ Housing
    □ Medical
    □ Food
    □ Technology
    □ Transportation
    □ Childcare Expenses
    □ Utilities
    □ Other: Please specify ________________________________________________

  4. Update your information by entering your bank routing number, bank account number, and mailing address below. The CARES funds will be disbursed via direct deposit if you provide accurate and updated banking information. If you do not provide banking information, funds will be disbursed via a check to the address you provide.

    Routing Number: __________________________
    Account Number: __________________________
    Address Line 1: ____________________________
    Address Line 2: ____________________________
    City: _____________________________________
    State: ____________________________________
    Zip Code: _________________________________

    □ I certify that this information is accurate, and understand that my CARES funds may be delayed if I submit invalid information.

    By submitting this form, you affirm that you understand that you are requesting funds, the award of which is based upon the accuracy of information you have provided, and you certify all information is true and correct to the best of your knowledge.

Open /*deleted href=#openmobile*/