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1718-loss-or-change-of-job Income - 1718 Loss or Change of Job_Income

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Student Name: _____________________________________________________________________________________
Student ID: _________________________________ OR Social Security Number: X X X – X X – ___ ___ ___ ___
Use this form to report when one or both parents of a dependent student or, for an independent student, the student or
the student’s spouse loses or changes jobs after filing the FAFSA resulting in reduced income.
1. Complete the following chart(s). Indicate the family member affected by the loss or change of job/income and list that
person’s name along with the date of employment/income loss or change and the date of new employment, if
applicable. Indicate actual and/or anticipated monthly gross income (wages) of the family member affected by the loss
or change of job/income in the Gross Income section. Indicate actual and/or anticipated monthly gross funds received
in the Gross Benefits section. Include severance pay, unemployment, disability, and current employment benefits (auto
allowance, travel, etc.). Complete the second chart only if more than one family member has been affected by a loss
or change of job/income.
Family Member 1
Month
July August September October November December
2017 2017 2017 2017 2017 2017
Gross
Income
Gross
Benefits
Month
January February March April May June
2018 2018 2018 2018 2018 2018
Gross
Income
Gross
Benefits
CONTINUED ON NEXT PAGE This form is not valid until you have signed and dated the next page
Financial Aid Office, IWU-National & Global 1900 West 50
th
Street Marion, IN 46953-9393 indwes.edu
800.621.8667 option 4 765.677.2516 765.677.2030 Fax IWUfinaid@indwes.edu
N
OTE: For each chart, i
a set amount of
income or benefits on a weekly basis
for the entire
duration of July 2017 through June 2018, please keep in mind that there are on average more than 4 weeks per
month. To correctly calculate monthly amounts, you must multiply the weekly amount by 4.3333 (weeks).
I
ndependent Student
Student _____ Student's Spouse _____
Dependent
Student
Student's (Step) Mother _____ Student's (Step) Father _____
EACH FIELD MUST CONTAIN A NUMERIC VALUE. ENTER $0, IF APPLICABLE.
Name of the affected family member: ________________________________________________________________
Date of employment/income loss or change (mmddccyy): ________________________________________________
Date of new employment, if applicable (mmddccyy): ____________________________________________________
201
7
-
201
8
SPECIAL CIRCUMSTANCES:
LOSS OR CHANGE OF JOB/INCOME
NATIONAL & GLOBAL
FINANCIAL AID OFFICE
Student Name: ________________________________________________ Student ID/SSN: ______________________
Family Member 2 (if applicable)
Month
July August September October November December
2017 2017 2017 2017 2017 2017
Gross
Income
Gross
Benefits
Month
January February March April May June
2018 2018 2018 2018 2018 2018
Gross
Income
Gross
Benefits
2. Attach required documentation:
a. 2015 Federal Income Tax Return
b. 2015 W2 form(s) for student and spouse, if applicable, for independent students or student’s parent(s), for
dependent students
c. Pay stub prior to the loss or change
d. Pay stub after the change, if applicable
e. Letter from HR Department or supervisor regarding the change
f. Online printout of unemployment benefits
Validation Statement: I certify the information provided is complete and true to the best of my knowledge. Furthermore,
I agree to contact the Financial Aid Office at the time there are changes to the situation on which the request for exception
has been founded. I understand that changes made to my student financial aid eligibility based upon the information
provided may affect only the student financial aid received at Indiana Wesleyan University for the 2017-2018 award year.
_________________________________________________________________________ ______________________
Student Signature Date
_________________________________________________________________________ ______________________
Parent Signature (for dependent student only) Date
Mail, email, or fax completed form and supporting documentation to:
Financial Aid Office, IWU-National & Global 1900 West 50
th
Street Marion, IN 46953-9393 indwes.edu
800.621.8667 option 4 765.677.2516 765.677.2030 Fax IWUfinaid@indwes.edu
EACH FIELD MUST CONTAIN A NUMERIC VALUE. ENTER $0, IF APPLICABLE.
Name of the affected family member: ________________________________________________________________
Date of employment/income loss or change (mmddccyy): ________________________________________________
Date of new employment, if applicable (mmddccyy): ____________________________________________________
201
7
-
2018
SPECIAL CIRCUMSTANCES:
LOSS OR CHANGE OF JOB/INCOME
NATIONAL & GLOBAL
FINANCIAL AID OFFICE
Independent Student
Student _____ Student's Spouse _____
Dependent
Student
Student's (Step) Mother _____ Student's (Step) Father _____
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Completed 16 November 2019

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