TCC Great Expectations Gas Card Application

Name(Required)

First Last

SIS Number(Required)

Do you currently work?(Required)

Yes

If so, how many hours per week?(Required)

Have you requested an HRT GoSemester from Great Expectations?(Required)

Yes

Please briefly share why you are requesting assistance with gas(Required)

I agree to use the gas card provided to me by the Great Expectations program for gas purchases only. I understand that it is non-transferrable. I will provide a detailed receipt to the Great Expectations Coordinator within 5 business days of the purchase. Failure to provide a gas receipt could jeopardize my future financial support from the Great Expectations program.(Required)

I agree

Signature(Required)