Special Circumstances Appeal Form (Page 2 of 2) in pdf

2. Provide a typed and signed statement with a detailed description of any extenuating

circumstances which you feel should warrant a re-evaluation of your circumstance; attach

the statement to your appeal paperwork.

3. Complete the following:

**** EXPECTED FAMILY INCOME AND RESOURCES IN 2016 ****

Please list all income/benefits expected to be received between January 1, 2016 and December 31, 2016. If an

item does not apply to you, please put a 0 (zero). Estimate your resources as accurately as possible to avoid the

need to correct information back to the original base-year income eligibility. A reversal of the Special Circumstance

may result in you (the student) owing money back to The Department of Education. Do not leave blanks.

Breakdown of Resources

Student

Parent(s) or Spouse

2016 Taxed Income

A. Work (wages earned)

$_______________

B. Alimony Received

$_______________

C. Unemployment Benefits

$_______________

D. 401K (not rolled over)

$_______________

E. Severance Pay

$_______________

2016 Untaxed Income & Benefits

F. Social Security

$________________

$_______________

G. Child support received for all children

$_______________

$______________

H. Disability Benefits

$_______________

$______________

Non-cash support provided by relatives/friends* $_______________

$______________

(this would include food, rent, utilities, etc.)

J. Other*

$_______________

$______________

Totals: (A thru J; both columns)

$_______________

*Name of Person providing support: _________________________ Relationship: _________________________

NOTE: ** All students requesting this consideration after January 1, 2017 will be required to submit their 2016

Federal Tax Return before a Special Circumstance Appeal will be considered.

SIGNATURE: My signature certifies that the information given is true, complete and correct. I have

read each section and provided the appropriate required documentation. I realize that if I do not

provide supporting documentation, no further action will be taken on this request.

Student’s Signature

Date

Parent’s or Spouse’s Signature

Date

Submit this signed worksheet with requested documents to:

Financial Aid Office ● Room 205B ● Morton College ● 3801 S. Central Ave., Cicero, IL. 60804

FOR FINANCIAL AID OFFICE USE ONLY

Approved Date: __________ Denied Date: __________ Pending Date: ___________

New EFC: _________

Decision letter sent: ____________

Comments:________________________________________________________________________________________________

__________________________________________________________________________________________________________

SCA Committee: __________________________________ SCA Committee: ____________________________________________

*Morton College does not discriminate on the basis of race, color, religion, national origin, gender, sexual orientation, age, marital status, or disability in its

educational, admissions or employment policies.

Updated on: 3/9/16

Special Circumstances Appeal Form Page 2

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