Special Circumstance Request Form 2014 - Huntsville Bible College (Page 2 of 2) in pdf

Special Circumstance Request Form 2014 - Huntsville Bible College Page 2

__ Death: Your spouse or parent who had earnings in 2013 has passed away.

Please Supply:

 Documentation of deceased 2014 earnings if applicable

 Documentation of death benefits received

 2013 verification documents

__ Disability: You, your spouse, or parent will earn less in 2014 due to disability.

Please Supply:

 A typed statement with dates explaining how disability affected income

 Documentation of 2014 earnings prior to disability

 Documentation of benefits received after disability

 2013 verification documents

__ One Time Income: You, your spouse, or your parent received a one-time income in 2013 that

will not be received in 2014 and this income was used for extraordinary expenses.

Please Supply:

 A typed statement and documentation explaining and proving the “extraordinary

expenses”

 Documentation of one-time payment

 2013 verification documents (Verification Worksheet and, if applicable, W2 forms)

__ Loss of Taxable or Untaxed Benefit: You, your spouse, or your parent received a benefit in

2013 that they will not receive or that was lost during 2014.

Please Supply:

 Documentation that benefit was terminated and documentation of benefit amount

received in 2014

 2013 Verification documents (Verification Worksheet and W2 forms)

__ Out of Pocket Medical Expenses: You or your parent paid medical bills in 2013 that were not

covered by insurance.

Please supply:

 Schedule A of federal tax return

 Proof of payment



2013 verification documents (Verification Worksheet and W2 forms)

Form #FA-2014-001, Original Version 0

Special Circumstance Request Form 2014 - Huntsville Bible College Page 2