2022-2023 RSPH Student Hardship Request Application

Full time MPH and MSPH students in good standing and making satisfactory academic progress, who experience a financial emergency or unanticipated expense causing financial hardship, may submit a request to be reviewed for assistance through school and/or university resources.

This form initiates a review process in which other offices such as the Emory University Office of Financial Aid and the Office of Student Success Programs may be contacted for additional support. Additional information may be requested by these offices. Please provide supplementary documents to support your request if relevant.

Please complete the following information and a representative from the RSPH Office of Admission and Student Services will contact you to determine next steps within 5 business days of receipt. Students in acute crisis should contact Student Intervention Services directly at sisteam@emory.edu, 404-430-1120. Submission of this form does not in any way guarantee that financial need may be met by this process. Consideration for school-based funds is contingent upon the availability of funding.

*Please note: It is our expectation that students will use all resources available to them to finance their education at Rollins including current salary, savings, investments, student loans, and the Emory Payment Plan if necessary.

Student Information

Emory Student ID Number (7 digits)

First Name

Last Name

Email Address

Department

Degree

MPH

MSPH

Please check if dual degree student. (Ex. MD/MPH, MBA/MPH, BS/MPH)

Dual Degree

Are you an International Student?

Yes

External Financial Resources for Students

Location of current employment:

On campus

Off campus

Other (please explain):

What external resources, agencies, and organizations have you reached out to for funding assistance?

List all external funding scholarships, grants or loans you have applied for:

List all funding assistance you are receiving from family and friends:

University Financial Resources for Students

Do you have Financial Aid from Emory?

Yes

List all Financial Aid funding received from Emory:

Please contact the Emory University Office of Financial Aid at gradfinaid@emory.edu or 404-727-6039 to learn about financial resources available to current students. You may also visit the Financing Your Degree information available on the Rollins website.

Are you enrolled in the Emory University Payment Plan?

Yes

Please contact the Emory University Student Financial Services Office at student.financials@emory.edu or 404-727-6095 for more information on enrolling in the Emory Payment Plan which divides your tuition payments into more manageable installments. You may also visit the Emory Payment Plan information available on the Student Financial Services website.

Have you applied for an Emergency Loan through Emory before?

Yes

Was the Emergency Loan approved?

Yes

What is the amount of Emergency Loan were you provided?

Have you sought assistance through other departments and/or programs within Emory University for your hardship?

Yes

What departments and/or programs within Emory University have you reached out to for help with your hardship?

Do you feel that you are in a crisis situation that requires additional assistance beyond financial needs?

Yes

Emory University has a Student Success Programs and Services department as a division of Campus Life that is available to all Rollins students. The Student Intervention Services (SIS) Team exists to help coordinate the University's response for students in distress.

If you have questions or are unsure of the best resource for you, please contact the SIS Team for assistance. You can make a referral online, and a member of the SIS Team will follow-up with you promptly. If you have an urgent concern please call the Emory Police Department at 404-727-6111 and ask them to page the Campus Life Professional on call.

You can learn more about the Student Success Programs and Services department via the website, as well as view a list of campus resources available to all University students.

Making a referral to the SIS team is simple. You can call 404-430-1120 or email sisteam@emory.edu to make a referral. All referrals are kept private to the fullest extent possible by law and consistent with university policy. Their goal is to help students be successful. No issue is too small to refer to them for assistance.

Demonstration of Financial Hardship Funding Needs

How much funding assistance are you requesting?

Please document the financial hardship that you are enduring at this time:

Do you anticipate this to be an ongoing hardship?

Yes

You may provide documentation to support your need for hardship funding. Materials to upload can include documentation that represent unusual uninsured medical expenses, uninsured losses caused by fire, crime, food or other disasters, death in the family, insupportable indebtedness occurring for reasons beyond the individual's control.

Public Health Goals

Describe how this additional funding will help facilitate your continued enrollment at Rollins:

Detail any significant or unusual financial circumstances that might prevent you from continuing your education at the Rollins School of Public Health:

Describe about how you hope to utilize your Public Health degree from Rollins to advance your career:

Certification and Authorization

With my signature below, I certify that the facts set forth in this application are true and complete to the best of my knowledge. RSPH has my permission to verify the information reported by obtaining documentation as needed. I understand that false statements on this application shall be considered a violation of the student honor code. I understand the Rollins Hardship Request conditions and procedure as stated above at the top of this application.

Print your full legal name (this will serve as your electronic signature)

Date: