2014-2015 Change Of Circumstance Form

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2014-2015 Change of Circumstance Form
Student’s Name ____________________________
Student ID #________________
Instructions
In some cases, if you have special circumstances due to a change in your household income, federal
regulations allow the re-evaluation of your financial aid eligibility. You must first file the FAFSA before
completing this form. If you would like to provide a statement regarding your change of circumstance,
please attach it to this form.
Circumstance:
Required Documentation
Loss of employment/retirement:
Name of person for whom circumstances have changed:
Unemployment period must have lasted at least 10
______________________________________
consecutive weeks. If the student is dependent and the
parent is unemployed or retired, provide the parent tax
Last date of employment: ____/____/______
information. If the student is independent and he/she
Amount earned in 2014 prior to unemployment? $__________
or spouse is unemployed/retired, provide the
student/spouse tax information.
Date unemployment benefits began: ____/____/______
Amount of weekly unemployment benefits$___________
Loss of Untaxed Income or Unemployment Benefits
The applicant, the applicant’s spouse, or parent
Date returned to work: ____/____/______
received untaxed income or unemployment benefits in
Gross monthly earnings: $____________________
2013 but lost this income in 2013 or 2014.
Is the person receiving severance pay?  Yes  No
NOTE: If the person is not eligible for unemployment
Severance received for 2013: $___________
compensation, please attach an explanation.
Severance received for 2014: $ __________
Severance remaining for 2014: $ __________
Please Provide:
 Copy of most recent pay stub in 2014
Date of retirement: ____/____/______
 Documentation of unemployment benefits
Amount earned in 2014 prior to retirement $_________
 2013 W2(s)
 2013 Signed Tax Return (1040/A/EZ)
Is the person receiving severance pay?  Yes  No
 Letter of Separation from Employer
Monthly pension payment received: $ __________
 Documentation of Pension Payments
Date Social Security began: ____/____/______
Note: Independent students are not required to provide
Gross monthly social security: $____________________
parent tax information.
Divorce or Separation
Date of divorce or separation: ____/____/______
The student or the parents have divorced or separated
since filing the FAFSA.
Weekly amount of child support received for all children
$____________________________________
Please Provide:
 Divorce decree or documentation of separate
Weekly amount of alimony $_____________________
address for separated persons
 2013 W2(s)
 2013 Signed Tax Return (1040/A/EZ)
Financial Aid Office |
finaid@centenarycollege.edu
|
400 Jefferson Street | Hackettstown, NJ 07840 | (T) 908-852-1400 ext. 2350 | (F) 908-813-2632
CHGCIR Updated 20140324

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