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NJFC SCHOLARS
Educational Support Request Form


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through EACH step of the online registration.
Filter Type:
Student Name
Street Address
City, State, Zip Code
Phone Number
Email Address (your address will not be shared or used for solicitation)
Will You Need Room and Board Assistance (Consists of Rent or Mortgage Payments)?
 Yes  No  Unsure
Amount Per Month
How Long Will You Require Assistance? (Max. of 4months)
Name, Address and Phone No. of Vendor/Landlord ( A copy of your current lease with a signature from your landlord/vendor must be submitted)
Vendor/Landlord Tax ID Number (W-9 Form Required)
Book Assistance
Cost of Books
Name, Address and Phone Number of Vendor
Will You RequireTransportation Assistance?
 Yes  No  Unsure
Type of Public Transportation
Cost Per Month
How Long Will You Require Assistance?
Name, Address and Phone Number of Vendor
You are only eligible to receive 1 Computer while participating in the NJFC Scholars Program.
You may not receive a computer during your first semester with the NJFC Scholars Program, and you must be in good standing.
Do You Need a Desktop Computer or a Laptop? (please specify)
Other Computer Equipment Needed (please explain)
Will You Need Assistance With Child Care Costs?
 Yes  No
Amount Needed Per Month
Number of Months of Assistance Needed
Name, Address and Phone # of Vendor
Vendor Tax ID Number (Required)
Equipment (Class Specific Equipment Needed)
 Yes  No
Explain Need for Equipment
Cost of Item
Name, Address and Phone # of Vendor
Additional Request
 Yes  No
Please Explain Any Additional Requests You May Have (Misc. funding will no longer be awarded without a specific use requested).
You will receive a confirmation email after you have completed this form.