Financial Aid Office P.O. Box 309 Jamestown, NC 27282
Phone: 336.334.4822 Option 3 Fax: 336.217-8468
2018-2019 Request for Consideration of Special Circumstances
Your 2019-19 financial aid is based on 2016 income reported on the FAFSA. If you and/or your parents experienced
a reduction in income or loss of employment that reduced their income or limits their ability to contribute toward
your educational expenses, you may request that the Financial
Aid Office review your circumstances. Complete and
return this form to the Financial Aid Office along with documentation to support your request.
Student Name: GTCC ID:
Please
Check
Change in Circumstance Required Supporting Information
Loss of Employment
(which reduces your family’s
anticipated 2017 total income)
• 2016 federal tax return with W‐2 statements (if not on file with
our office)
• Copy of the last/most recent pay stub
• Termination /Severance Notice(if applicable)
• Copy of unemployment benefits (if applicable)
Significant Change in Income
• 2016 federal tax return with W‐2 statements (if not on file with
our office)
• Copy of last/most recent pay stub
• Letter of explanation from employer (if
applicable)
One-time/Non-
Recurring Income
• Clarification (e.g., IRA distribution, sale of property,
inheritance, Form 1099)
• Explanation of how income was used with documentation of
expenditures
Medical Expenses
( exceeding 3.8% of
Adjusted Gross Income)
• Explanation of special circumstances and estimate of 2018
medical expenses not reimbursed or paid by insurance
• Documentation of outstanding/prior year medical bills not
reimbursed or paid by insurance
Separation/Divorce/Death
• 2016 federal tax return with W‐2 statements (if not on file with
our office)
• Copy of separation/divorce document.
• Death certificate
Other
(e.g., natural disaster)
• Description and documentation of the circumstance.
(Continued)
Phone:
