CSUCares Fund
Application for Relief

If you have been impacted as a result of Colorado natural disasters, CSUCares may help meet some of your financial needs. Please fill out this form completely and submit it by clicking the button at the bottom of the page. Award amounts vary depending on fund availability and need, but generally do not exceed $2,000.  While this fund will be used now to assist those impacted by the recent floods, it will remain in place to assist those in the CSU community who are impacted by future disasters.


Colorado State University

My Information
Full Name
Prefix First Middle Last Suffix(es)
CSU ID

Address
Home Business
Street 1
Street 2
City State Zip Code
Country
Phone Number

Contact Information
Cell Phone
E-mail Address

Application Questions
Colorado State University Date of Loss:   

Best way to communicate with you:   

1. What is your connection to CSU?
I am a regular full-time faculty member
I am a regular part-time faculty member
I am a regular full-time staff member
I am a regular part-time staff member
I am a student
I am a retired

2. Did the property loss occur during your employment/enrollment with CSU?
Yes
No

3. Are any other CSU employees/students living in your household?
If yes, please list their names.
Yes
No
   

4. Did you lose your entire home or residence?
Yes
No

5. Statement of Loss. Please describe your financial loss and the circumstances that led to your loss.
   

6. Amount of funding requested:
   

7. If approved, how will the grant be spent?
Please include an estimate of the cost of any temporary shelter, food, or other non-reimbursable basic needs required as a result of your loss. By law, these grants cannot cover any expenses covered by insurance.
   

8. Please note anything else you would like us to know.
   

CSU Employee Assistance Program staff or a Student Case Manager may be contacting you to discuss additional needs and resources. For more information, contact Lanai Greenhalgh at (970) 491-1527 (employees) or (970) 491-8051 (students).

EMPLOYEE/STUDENT CERTIFICATION

By entering your name in the field below, you certify that the information provided in this application is accurate and your hardship is genuine. You understand that any intentional misrepresentation of information contained in this application will result in forfeiture of this grant and ineligibility for future grants.
   

9. If your grant is approved, how would you like to be paid?
I prefer to pick up my check in person. (If approved, CSUCares will contact you to arrange pickup).
Please mail the check to the following address
   

Paper submissions may be mailed to:
Colorado State University
102 Administration
Fort Collins, CO 80523

Email Inquiries to:
csucares@colostate.edu
If you see this field, please leave it empty.





Help Desk/Technical Questions: ADVRequest@ua.colostate.edu or (970) 491-4887

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