Graduate School Funding Administration's General Form

Please note this form is to be used for Overload Petitions, Requests for Matching Fellowship Funds, and Emergency Grant Applications.

Please make a selection from the list below:

Please fill out the following information for the individual submitting the form:

First Name

Last Name

Email Address

Department/Program

Overload Petition

Please note you will need to obtain signatures using this document prior to submitting this form.

Student Name:

Student Email Address:

Is the student seeking overload domestic, foreign national or permanent resident?

United States Citizen

Foreign National

United States Permanent Resident

Please note that international students on an F-1 Visa may never work over 20 hours/week while classes are in session. Please write to ISSS@colorado.edu with questions on this policy.

Home Department/Program:

Name of Academic Advisor:

Employing Department (if different from home department):

Student ID (9-digits):

Student GPA (please list undergraduate GPA if first-year graduate student):

Term during which the overload will occur (overload petitions must be submitted for each term and will not be approved for a full academic year):

Please list the combined (including overload) percentage of appointments (i.e. 25 hours/week = 62.5%):

Are any of these appointments hourly?

Yes

Details regarding the additional appointment (date/length of appointment, percentage of time, type of work, benefit to student, etc.):

Current academic status (status of graduate career, dissertation progress, etc.):

Please certify below that the student has received approval from their academic advisor regarding this workload, and the academic advisor will monitor the student’s academic progress to ensure that the additional work does not negatively affect the student's studies.

Yes

Required Signatures

Please upload the document referenced at the top of this form containing required signatures from the student, academic advisor, and department's graduate program coordinator/HR representative.

Request for Paid Parental Leave for Students on Appointment

Please note this form must be submitted at least six weeks prior to leave request. Additionally, you will need to obtain signatures using this document prior to submitting this form.

Student Name:

Student Email Address:

Student ID (9-digits):

Student Employee ID (6-digits):

Academic Advisor (Name, Email):

Student's Employing Department:

Supervisor (Name, Email):

Appointment Details:

Type of Appointment:

Appointment Percentage:

Dates of Appointment:

Dates of Leave:

Required Signatures

Please upload the document referenced at the top of this form containing required signatures from the student, supervisor, and chair of employing department.

PPRA Academic Work Plan

Assistantship Duties Work Plan

Medical Provider or Adoption Agency Documentation

Please upload documentation from a medical provider or adoption agency detailing the anticipated birth or adoption:

Request for Matching Fellowship Funds

Student Name:

Student Email Address:

Student Department/Program:

Student ID (9-digits):

Name of Fellowship:

Duration of Fellowship:

Please include a brief description of the fellowship:

Please detail the amount of funding being offered through the fellowship:

What are you requesting matching funds for (i.e. tuition/fees/insurance, tuition only, etc)?

Please indicate what semesters you are requesting support for:

Fellowship Offer Letter

Please upload the student's fellowship offer letter:

Emergency Grant Application

The University of Colorado Boulder Graduate School Emergency Fund is intended to help meet the financial needs of current CU Boulder graduate students who encounter an emergency situation resulting in unforeseen expenses during their degree program. Newly admitted graduate students may receive emergency funding for qualifying unforeseen expenses incurred within 30 days prior to the start of their first enrolled term or after the term begins.

This program does not cover students enrolled through Continuing Education, the Law School, or the Leeds MBA program.

Eligibility: Students must be full-time enrolled in a CU Boulder graduate degree program on main campus. Please note students may only receive assistance from this emergency fund twice during their graduate degree program.

Situations eligible for funding (up to $2,500.00) include events such as:

Medical, dental* or mental health emergencies for the student or, in some circumstances, for immediate family members (e.g. spouse, partner, child) who live with the student.
- Dental expenses are only eligible if they are caused by an accident or injury, otherwise any necessary/required procedures that are not covered by insurance may be eligible for up to $500.
Major accidents and events such as fire, flooding, and natural disasters.
Support shelter for a student in a dangerous situation due to acts of violence or other victimization.
To fund travel home due to immediate family (parent, sibling or child) emergency, crisis, or death.

The following situations are ineligible for funding:

Assistance with ongoing medical costs/prescriptions.
Assistance with recurring academic expenses.
Housing (i.e. rent, utilities, etc.) or food insecurity.
Routine or expected living expenses, including vehicle maintenance and mechanical repairs, child care, taxes, insurance, pet-related expenses, and computer/laptop replacement, etc.
Other recurring costs.

Please upload any receipts, bills, or other supporting documentation below. We are not able to accept Explanation of Benefits (EOB) documentation or grant funding based on estimated patient costs. Documentation must show the amount actually paid by the student or the amount for which the student is currently responsible.

Please note that this is a discretionary fund that is also dependent upon available funding. If your request for emergency funding is denied, there is no appeal process.

Student Name:

Student Email Address:

Student Department/Program:

Student ID (9-digits):

Please include a brief statement describing the emergency situation or one-time, unusual, or unforeseen expense:

Please indicate the total dollar amount being requested (not to exceed $2,500.00):

Please include a budget detailing the amount of emergency funding requested and a list of the specific expenses to be covered by the award:

Please include any receipts, bills, or other supporting documentation, combined and uploaded as one PDF:

Please describe your financial situation including sources of income and other available funding:

Have you applied for other university-sponsored emergency funding?

Yes

Please indicate what other university-sponsored emergency funding you have applied to, whether your request was approved, denied or is still pending, and how much money you have or expect to receive:

Please provide your current mailing address:

CU Boulder has a responsibility to provide a safe and nondiscriminatory environment. If you disclose having been impacted by sexual misconduct, protected-class discrimination or harassment, intimate partner violence, stalking, or related retaliation, we are required to share that information to the CU Office of Institutional Equity and Compliance (OIEC) for outreach regarding support and reporting options. You are not required to respond to OIEC. If you are in need of support, here is a list of resources, including confidential assistance. If you have questions before you want to submit this type of information, please contact the confidential Office of Victim Assistance.

Additionally, please note that the university takes disclosures around threat of harm to self or others seriously and when information of this nature is received, it will be shared with the appropriate offices to offer additional support and resources.