I certify that the information provided is true and correct to the best of my knowledge, and that any money received will be used to relieve the stated financial hardship. I agree to provide with documentation regarding my hardship upon request. I also understand that money received from this fund will be treated as taxable income and is a one-time award. Any intentional misrepresentation of information contained in this application or shared during its review will result in forfeiting this and any future application for assistance, possible disciplinary action and a potential demand for repayment of funds issued. Furthermore, I understand that the completion of this application does not guarantee funding, and that if needed I will address any concerns or questions related to my application.