Independent Professional Judgment Application (Page 2 of 2) in pdf

Banner ID: _________________

STEP THREE: Explanation of Circumstances and Additional Required Documents

SITUATION

REQUIRED DOCUMENTATION

(check the box for your situation)

(check if included)

Copy of 2014 Federal Tax Return Transcript (from IRS)

Copies of all 2014 W-2 and 1099 forms

You were employed full-time (at least 35 hours per week)

for at least 30 weeks in 2014, but are not working full-time

2015-2016 Independent Verification Worksheet

now.

Employer’s written notice of termination of employment

Copies of most recent pay stubs for all 2015 employment

Your spouse was employed full-time (at least 35 hours per

week) for at least 30 weeks in 2014 but lost employment for

Copy of Benefit Payment History for all unemployment

at least 10 consecutive weeks and is not working full-time

compensation received

now.

Document all others sources of income (taxed & untaxed)

In Addition (as applicable)

You or your spouse lost employment due to a disability or

Attending physician’s statement of disability

federally designated natural disaster for more than 10

consecutive weeks in 2014. This situation must be a total

Document date disability/disaster caused unemployment

loss of employment

Documentation of employer disability payments

Number of weeks unemployed in 2014: ___________

Documentation of Worker’s Compensation received

Document Official Declaration of Natural Disaster status

Copy of 2014 Federal Tax Return Transcript (from IRS)

You or your spouse had a total loss of untaxed income.

Copies of all 2014 W-2 and 1099 forms

Benefit Lost:

2015-2016 Independent Verification Worksheet

Unemployment

Benefit provider’s notification of loss of benefit

Copies of most recent pay stubs for all 2015 earnings

Social Security

Document all others sources of income (taxed & untaxed)

In Addition (as applicable)

Child Support

Copy of Benefit Payment History for all unemployment

Last Date Benefit Received: ____________________

compensation received

Court documents verifying date of loss of child support

Copy of 2014 Federal Tax Return Transcript (from IRS)

You have already filed your FAFSA and since that time:

Copies of all 2014 W-2 and 1099 forms

2015-2016 Independent Verification Worksheet

You have separated/divorced. Date:___________

In Addition (as applicable)

Copy of court documented separation/divorce decree

Your spouse has passed away. Date:___________

Copy of spouse’s death certificate or obituary

Copy of 2014 Federal Tax Return Transcript (from IRS)

Other: __________________________

Copies of all 2014 W-2 and 1099 forms

2015-2016 Independent Verification Worksheet

Letter of explanation regarding your situation

By signing below, we certify that the information provided on this form is true and correct to the best of our knowledge. We understand

that completing this form does not guarantee financial aid will be increased. We agree that if requested, we will provide documentation to

support the information provided on this form. We understand that failure to provide the requested information will result in denial of this

application. We understand that this form does not guarantee a change in the amounts or types of financial aid awarded and that

professional judgment decision may result in decreased eligibility for certain financial aid programs. The Office of Financial Aid reserves

the right to review all requests on a case by case basis and make adjustments if deemed appropriate.

_____________________________________________

______________________________________________

Student’s Signature

Date

Spouse’s Signature (if applicable)

Date

This publication is available in alternative formats upon request.

Please contact the Accessibility Resource Center, D.F. Lowry Building, 521-6695.

Revised 09/2015

Independent Professional Judgment Application Page 2

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