Special Circumstances Request Form printable pdf download

Special Circumstances Request Form

Student’s Name ___________________________________

Student’s ID ______________

If your family’s 2015 income is significantly less than your family’s 2014 income due to one of the circumstances

described below you qualify for a special circumstances review. If your situation is not reflected in any of the conditions

outlined below and you feel you may qualify for a special circumstances review please contact the financial aid office.

In order to have your special circumstances request reviewed you must complete this form and submit all required

documentation outlined below.

Please check the appropriate box

I am an independent student and my income and/or my spouse’s income will be substantially less in 2015 than 2014

I am a dependent student and my parent’s income will be substantially less in 2015 than 2014

Please check the reason that best describes your situation and supply all the required documentation listed

_____ UNEMPLOYMENT- You, your spouse, or your parent who worked in 2014 has been unemployed for at least 4

weeks in 2015 and will earn less money in 2015 than 2014

Please supply:



A typed statement that includes dates and explains the changes in your employment history from Jan 1

2015 till present



Copy of final paystub containing 2015 year to date earnings



Documentation of any benefits received in 2015 (unemployment, severance etc.)



Termination letter (if received)



Income verification for 2014 including but not limited to Federal Tax return and W2 forms

_____ SEPERATION/DIVORCE- You or parent got divorce after the date you filed the FAFSA

Please supply:



Proof of divorce or separate addresses



Letter of explanation giving dates and details as to disposition of assets etc.



Income verification for 2014 including but not limited to Federal Tax return and W2 forms

Special Circumstances Request Form