Reynolds Community College recognizes that the COVID-19 pandemic has impacted our students. We care about you and we are committed to trying to assist you during this unprecedented time. The COVID-19 Emergency Fund/Request Form was established to assist students that have experienced exceptional hardship. 
Reynolds, the Opportunity College

Criteria to be eligible for Emergency Funds includes, but is not limited to, the following:
o Actively enrolled for Spring 2020 term as of National Emergency Declaration (3/13/2020);
o Not be enrolled exclusively in online courses as of 3/13/2020;
o Must be a U.S. citizen or eligible non-citizen;
o If male between 18-25 years old, you must be registered with Selective Service;you can register for Selective Service at
o Must not be in default on a federal student loan;

    o For a full listing of eligibility criteria, please see
Last Name:(Required) 

First Name:(Required) 


Student Id:(Required) 


Reynolds VCCS Email Address: (Required) 

Date: (Required)

Expected Graduation Term (please select one of the following):
Which of the Following Have You Experienced as a Result of COVID-19 and/or Related to Disruption of Education? (check all that apply):
Loss of income:

*Please note: The maximum award is $500. Funding is limited and approval is not guaranteed. If you have not already provided the college with your Social Security Card, please do so. For instructions, please complete and submit Form 11-0007 with social security number and driver's license (or government-issued picture ID).

Have you been convicted for the possession or sale of illegal drugs for an offense that occurred while you were receiving federal student aid (such as grants, work-study, or loans)?

Answer 'No' if you have never received federal student aid or if you have never had a drug conviction for an offense that occurred while receiving federal student aid. If you have a drug conviction for an offense that occurred while you were receiving federal student aid, answer 'Yes,' but complete and submit this application, and we will mail you a worksheet to help you determine if your conviction affects your eligibility for aid. If you are unsure how to answer this question, call 1-800-433-3243 for help.

Attestation statement:
I, (), attest that all information provided on this statement is accurate and I meet all of the stated criteria for the CARES Act Emergency Fund.

Agree with Attestation Statement.