Basic Needs Assistance Request

This form will be assessed to provide individual resource suggestions and options to meet with you for further care coordination. Once you submit the form you will be automatically redirected to our Basic Needs Resources page and a staff member will respond to your request within 1-3 business days. 

If you have any questions regarding financial aid, please contact The Office of Student Financial Aid at or by phone – 608.262.3060 between 8 am – 4 pm Monday thru Friday. 

  • Please provide your email, if you have one.
  • Note

    By submitting this form, you understand the Basic Needs Office Staff are mandated Title IX reporters. Title IX includes incidents of sexual assault/harassment, dating/domestic violence, abuse, and neglect.
  • This field is for validation purposes and should be left unchanged.