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The U.S. Department of Education has released additional emergency grant funds (HEERF) to be disbursed to qualifying students in the near future. With this disbursement students have the option to authorize the payments go toward any outstanding student account balances. If you qualify for a disbursement and have an outstanding account balance and you would like for it to be applied to your account balance you can indicate this below. Any remaining funds will be disbursed to you directly.

NOTE: This does not guarantee that you will or will not qualify for emergency grant funds. The process of determining who will qualify is ongoing and a final list is being prepared. You can check your account balances here: Login Page ( Click “Student and Staff”, Put in your 9XXXXXXXX student ID number and password on the next page. This will take you to your account.

Please check the box to indicate your choice

 Yes. If I qualify, apply any HEERF emergency funding to any eligible outstanding balance on my account first. I understand that I will only receive a refund if the funding exceeds my outstanding balance. I also understand that I may still owe a balance after eligible funding is applied.

 No. If I qualify, do not apply HEERF emergency funding to any eligible outstanding balance. I understand that if I receive a refund I may still have a balance due to the institution.

Student Signature: _____________________________ Date: _____________________

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Northeast State Community College, a Tennessee Board of Regents institution, is an equal opportunity, affirmative action institution. For questions or concerns, please contact the Affirmative Action Officer.