Change Of Financial Situation Independent
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Uni versi ty of Illi nois S pringfiel d – Office of Financial Assistance
One Universtiy Plaza, MS UHB 1015 Springfield, Illinois 627035407 Phone: (217) 2066724
20122013 Change of Financial Situation Independent
Section A –
Student Information (Please print clearly)
Last Name
First Name
M.I.
Email
Street Address
City
State
Zip Code
:
What you should do
If the information you have reported on your 201213 Free Application for Federal Student Aid (FAFSA) does not accurately reflect your
current situation, you may be eligible to have your financial aid file reevaluated. In order to have your file reevaluated, you must submit
ALL of the following information:
Independent Student (per the FAFSA)
Complete and submit this entire form per the instructions with appropriate documentation.
___
___ Submit 8 ½ x 11 legible copies of all 2011 W2 forms/benefit statements and signed federal income tax returns for
yourself (and spouse if married).
___ Submit a 201213 Independent Verification Worksheet.
If this form is not completed and the proper documentation is not submitted, your file will not be reviewed. Keep in mind that as a
result of reviewing the additional documentation submitted there may be an increase or decrease in your financial aid eligibility. If your
financial aid eligibility changes, you will be notified accordingly.
Section B –
Indicate Reason(s) for Change of Financial Situation
____ A.
Unusual medical or dental expenses paid not covered by insurance and not claimed as a deduction on your Federal income tax return during
the 2011 tax year (January 1, 2011 December 31, 2011). As a general rule, these expenses should be at least 15% of your Adjusted Gross
Income before submitting documentation. Documentation required: proof of payment such as canceled checks or receipts (please total
amounts).
____ B.
If you or your spouse worked fulltime in 2011 but lost his/her job and remained unemployed for at least 10 weeks during 2012 or if you or
your spouse were employed fulltime in 2011, but now are only employed parttime in 2012. As a general rule, the projected 2012 Adjusted
Gross Income (AGI) should be at least 20% less than the actual 2011 AGI before submitting documentation. Documentation required: a
statement from previous employer on company letter head indicating the first and last day of employment or in the case of reduced hours, a
similar letter stating your hours have been reduced.
____ C.
If you or your spouse worked fulltime in 2011 but have been unable to pursue normal income producing activities for at least 10 weeks
during 2011 due to a disability, etc. As a general rule, the projected 2012 Adjusted Gross Income (AGI) should be at least 20% less than the
actual 2011 AGI before submitting documentation. Documentation required: a letter from a physician regarding the disability or a letter
from another source documenting reason.
____ D.
If you or your spouse received untaxed income in 2011 and had a complete loss of one of the benefits for at least 10 weeks in 2012. This
would include Child Support, Disability Benefits, and Veterans Benefits. As a general rule, the projected 2012 total income should be at least
20% less than the actual 2011 total income before submitting documentation. Documentation required: a written statement from the
appropriate agency showing the date the benefit was lost.
____ E.
If you or your spouse have become separated or divorced after submission of your original FAFSA. Please list the date of separation or
divorce: _____/_____/_____. Documentation required: copy of the temporary separation order or divorce decree from the court or
documentation such as lease, mortgage, etc. which shows two separate households.
____ F.
If your spouse, whose 2011 income was reported on the FAFSA, has died after submission of the FAFSA application. Documentation
required: Death Certificate.
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