2019-20 SPECIAL CONDITIONS APPEAL
(2019-2020 Academic Year)
2800 S Lone Tree Rd Flagstaff, AZ 86005-2701 PH: 928-226-4219 FAX: 928-226-4110 email@example.com
FA400-Special Conditions Appeal 20181003
This form is accepted from July 1, 2019 – November 15, 2019 and from *February 1, 2020 – June 30, 2020
*Students appealing for the 2019 calendar year and are submitting the appeal after November 15, 2019, must submit their
2019 Tax Return Transcripts and 2019 W-2’s for the Student / Parent / Spouse.
If your financial situation has changed since 2017, you may complete this form to request a FAFSA adjustment for the 2019-20
school year. You may request an adjustment to your income based on your 2018 actual earnings OR your 2019 estimated
earnings. The Financial Aid Office can help you determine which scenario will more accurately reflect your ability to pay for college.
Professional judgment evaluations are made on a case-by-case basis and do not guarantee eligibility for aid. Allow 10 business
days after the financial aid file has been verified for the appeal to be reviewed; if corrections are required during initial
verification, the process will be delayed.
All appeals must include the following documentation:
• A s
igned and dated statement explaining your appealable situation from both parent(s) and student. Both must submit
their own signed statement with this completed form. Please be specific and include pertinent details (e.g. what has
changed, why the change occurred, and the dates changes occurred.) The specific details help us to better understand
your particular situation.
• A copy of 2017 Tax Return Transcripts for the student/parent(s)/spouse if the Data Retrieval Option on the FAFSA was
• Copies of all 2017 W-2’s for student/parent(s)/spouse.
• Dependent / Independent Verification Form 2019-2020 (available at CCC website under Financial Aid Forms page)
In the table below, check the special circumstance that applies to you or your family situation.
of employment or
income earned in
2018 or 2019 is less
than that earned in
earned in 2018 or
2019 is less than that
earned in 2017.
• 2018 W-2’s (Student /Parent/Spouse – only if
appealing to use 2017 income
• 2018 Tax Return Transcript– only if appealing to use
• Final or Most Current Paystub for Student/Parent/
Spouse with Year to Date Earnings
– only if appealing
ination letter from employer (if applicable)
• Unemployment Benefit Summary (if applicable)
e of Change:
divorced; or widowed
after the FAFSA was
or widowed after the
FAFSA was filed.
Provide documentation applicable to your situation:
• Copy of Marriage Certificate
• Copy of Divorce decree or legal separation
• Proof of separate residence for both parties
• Copy of Death Certificate (if applicable)
received a one-time
payment (lump sum)
spouse) received a
• Write a statement and provided documents detailing
loss of one-time payment.
CCC ID# Last Name First Name MI
Mailing Address City State Zip Code
Telephone No. (include area code) Email Address