Schenectady County Community College Foundation
Employee Relief Fund Application
SCHENECTADY
COUNTY
COMMUNITY
COLLEGE
_____________________________________________________________________________________
_____________________________________________________________________________________
Name: Employee ID #:
Address:
City: State: Zip:
Email: Phone Number:
Amount Requested: $
Please attach copies (no originals) of back-updocumentation
Describe the crisis causing your financial emergency:
Describe what the emergency financial assistance will be used for:
I have read and understand the Employee Relief Fund Guidelines.
I give SUNY Schenectady and the Foundation permission to use my
circumstances (without names or other identifying information) as examples of
those who benefitted from the Employee Relief Fund.
Date: ____________ Employee Signature:
Please return this form to Human Resources.
Approved (Amount: $__________)
Denied
Reviewer Name:
___________________________________________________
Signature: __________________________________________ Date: ________________
For Official Use Only
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