Basic Needs Assistance Request

The Basic Needs Team within the Office of Student Financial Aid will review the Basic Needs Assistant Request form. 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.

Name(Required)

First Last

Pronouns

Phone

Email Address(Required)

Please provide your @wisc.edu email, if you have one.

Campus ID Number

Preferred Contact Method(Required)

Phone

Other

I am reaching out to get support with (check all that apply)(Required)

Housing

Food Access

Clothing

Health Insurance

Mental Health Services

Technology Needs

All the Above

Other (Please share below)

Please briefly describe the situation we can support you with:*(Required)

Please indicate if you are a part of any of the following programs (check all that apply)(Required)

Financial Aid Promise Program (FASTrack/Banner, Bucky's Tuition Program, Bucky's Pell Pathway, etc.)

Federal Work-Study

ACCESS

None of the Above

Acknowledgement(Required)

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.

If you would like to better understand Mandating Reporting before connecting with the Basic Needs team, please check out this website: https://compliance.wisc.edu/titleix/mandatory-reporting/

Name

This field is for validation purposes and should be left unchanged.

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