* Required field  
*Are you a credit or noncredit (Workforce Development) student?

*Which fund best fits your request?

Gettysburg Campus-Related Emergency Assistance Funds


Harrisburg Campus-Related Emergency Assistance Fund


Lancaster Campus-Related Emergency Assistance Funds


Lebanon Campus-Related Emergency Assistance Funds



York Campus-Related Emergency Assistance Fund



Virtual Learning-Related Emergency Assistance Fund



Massage Therapy-Related Emergency Assistance Fund


  Photography-Related Emergency Assistance Fund

Emergency Assistance Fund for Any Student


Student Information  
* First name:  
* Middle Initial:  
* Last name:  
* Phone number:  
* Street address:  
* City:  
* State:   * Zip
* Email:  
* HACC ID:  
HAWKMail email:  

Please select your location:

For what term are you requesting emergency assistance?

Please type the year:  
Please select what you will be using these funds for (check all that apply):

If you selected home catastrophe, auto repairs or other, please describe:


* Please enter the amount you are requesting:

* In at least 75 words, please provide a written statement explaining why you are requesting help from the emergency assistance fund. (If your explanation is fewer than 75 words, your application will be rejected):

Are you receiving Temporary Assistance for Needy Families (TANF) or Supplemental Nutrition Assistance Program (SNAP) funds?

Vendor information  
* Description of request:  
* Confirm amount of request:  
* Vendor name:  
* Vendor street address:  
* Vendor city:  
* Vendor state:   Vendor zip:  
* Vendor phone:  
Vendor account number (if applicable):  

Additional documentation: 

  • Please copy and paste your unofficial HACC transcript in a Word document.
  • Please provide your documentation from the vendor.
  • Please email to emergencyassistance@hacc.edu.
  • Requests will not be considered without these two documents.
Lancaster Campus-Related Emergency Assistance Funds

By utilizing my electronic signature, I certify that all of the information I have provided is true and correct to the best of my knowledge. I also understand that providing incomplete and/or inaccurate information will result in my request being denied.
* Student first and last name:                 * Date:   mm/dd/yyyy