Please contact Lisa Carter at 541-880-2234 or carter@klamathcc.edu to get help filling out this form.

Date:

Student ID number

First name:

Last name:

Phone number

Email

Street address:

City:

State:

Zip code:

What program(s) at Klamath Community College are you currently enrolled in?

Have you received EAO funding in the past?        

How much are you requesting?

Describe what you would use these funds for:

Upload your letter of recommendation. 

Certification and Consent to Release Information for All Applicants: 

I certify that all information I have provided on this form is true and complete to the best of my knowledge. I agree to give proof of the information on this application if requested. I give permission to selection committees to review information on this form, my transcripts, my need for financial assistance based on federally approved need analysis, and any additional supporting documentation submitted as part of this application. I give permission for selection committees to contact high school and college officials for additional academic and/or financial information. If selected to receive funding, I give permission for a publicity release. I give my consent to college officials to release any information regarding my performance as a student, which may include information contained within student records. I commit to helping the Foundation with events and fundraising efforts. My consent for release will remain in effect from the date indicated below until I submit written notification rescinding this request. 

Signature:

(By typing your name into the box you are providing an electronic signature.)

The Klamath Community College Foundation does not discriminate in any programs, activities, or services on the basis of race, color, religion, ethnicity, use of native language, national origin, sex, sexual orientation, gender identity, marital status, veteran status, disability, age, pregnancy, or any other status protected under applicable federal, state, or local laws. We comply with all applicable federal, state, and local laws regarding nondiscrimination and equal opportunity. For further policy information and for a full list of regulatory specific contact persons visit the webpage here.