Reconsideration Form - Kamehameha Schools Page 4
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Written statement with detail explanation and itemize list of “how the
Capital gains, IRA withdrawals,
money was spent.”
Miscellaneous income, Gambling
earnings
Provide documentation: HUD Statements, Educational Loan Statements, Legal
Fees and/or Major Medical/Hospital Invoices.
7. Medical/dental (non-cosmetic only)
Total expenses incurred.
expenses not covered by insurance.
a.
Copy of the most current medical/dental bill statement showing
amounts paid and outstanding.
Documentation from agency verifying date and amount of benefits
8. Loss of child support
terminated and amount received (if any) in the current year for all
family members.
9. Loss of disability benefits
Copy of disability benefits termination letter disclosing effective date.
Proof of disability status. (i.e. medical documentation, letter from
vocational rehabilitation, etc.)
Copy of the death certificate and documentation regarding any
10. Death of family member
anticipated insurance and/or untaxed income for the current year.
11. Other
Case by case requirements may be requested. Supporting documentation is
required.
Document No. 065AI
Rev. 3/1/2017
Page 4 of 4
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