Fillable 2019-20 Special Circumstances Appeal Form (Lehigh Carbon Community College)

Fill Online, Printable, Fillable, Blank 2019-20 Special Circumstances Appeal Form (Lehigh Carbon Community College) Form

Use Fill to complete blank online LEHIGH CARBON COMMUNITY COLLEGE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

2019-20 Special Circumstances Appeal Form (Lehigh Carbon Community College)

On average this form takes 14 minutes to complete

The 2019-20 Special Circumstances Appeal Form (Lehigh Carbon Community College) form is 3 pages long and contains:

  • 0 signatures
  • 6 check-boxes
  • 54 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Lehigh Carbon Community College

BROWSE LEHIGH CARBON COMMUNITY COLLEGE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
OFFICE OF FINANCIAL AID
4525 Education Park Drive, Schnecksville, PA 18078
P 610.799.1133 | F 610.799.1798
E finaid@mymail.lccc.edu
2019-20 Special Circumstances Appeal Form
Student Name Student ID
Purpose
The 2019-20 FAFSA takes into account 2017 tax year income. If your family’s current financial situation is drastically
different then it was in 2017, you may wish to consider submitting this form. Upon review, the Financial Aid Office
may deem it appropriate for your FAFSA information to be adjusted to be more equitable and representative of your
current financial situation.
Instructions
Complete sections 1 through 3 and ALL required steps below.
Deadline
For the 2019-20 academic year, the deadline for consideration is April 15, 2020.
U1. SPECIAL CONDITION(S)
Indicate the appropriate reason(s) and the date(s) of your family's change in circumstance by checking the box(es)
below. You will need to attach the required supporting documentation indicated below the applicable
circumstance(s).
Loss of employment or change in employment status since 2017
• Letter from employer on company letterhead that includes the last date of employment.
• Unemployment benefits determination document.
• Documentation of year-to-date income.
Month/Day/Year
Loss of 2017 earnings due to disability or natural disaster
• Documentation of disability determination.
• Documentation of natural disaster.
Month/Day/Year
• Documentation of year-to-date income (copies of most recent pay stubs from all employers).
Loss of 2017 untaxed income or benefit
(Benefits received in 2017 were terminated or reduced in 2019)
• Copy of notification of benefits reduction/termination, including the effective date.
• Documentation of 2019 expected benefits.
• Documentation of Social Security benefits termination due to child reaching age 18.
• Documentation of year-to-date income.
Month/Day/Year
Separation or divorce since 2017 - Parties must live in separate residences
• Speak with the Financial Aid Office if the divorce or separation occurred before
you completed the 2019-2020 FAFSA. Do not submit a Special Circumstances Appeal Form.
• Copy of divorce decree, or documentation of separation (Separate Maintenance
Agreement or Attorney’s Letter and proof of separate residences. If legal documents
do not exist, submit an explanation.)
• Total 2019 net worth or liquid assets.
Month/Day/Year
• Copy of 2018 Federal UTax Return Transcript(s)U and all 2018 W-2 form(s). For information on how to obtain a
tax return transcript, https://www.irs.gov/individuals/get-transcript.
Page 1 of 3
OFFICE USE ONLY: SPECCO
Death of parent/spouse since 2017
• Copy of death certificate.
Month/Day/Year
• Complete Section B only for surviving parent/student and attach income documentation
(e.g. copy of last pay stub, proof of unemployment benefits) only for the surviving
parent/student.
Other
Provide a detailed explanation and attach documentation for the circumstance(s) impacting the reduction in your
2019 family income as compared to your 2017 income. If additional space is needed, attach a separate sheet.
Page 2 of 3
OFFICE OF FINANCIAL AID
4525 Education Park Drive, Schnecksville, PA 18078
P 610.799.1133 | F 610.799.1798
E finaid@mymail.lccc.edu
U2. STATEMENT OF ESTIMATED 2018 INCOME
Estimate your family income for the entire year (January 1, 2019 to December 31, 2019) by indicating the annual
amounts in each space below. If the question does not apply to you, indicate ‘0’ - do not leave any lines blank. This
form will be returned to you if it is incomplete and this will delay the processing of your financial aid.
If the student is Dependent, list parent(s) and/or student’s information.
If the student is Independent, list student’s and/or spouse’s (if applicable) information.
Dependent Student’s
Parent(s) Information
&/OR
Dependent or Independent
Student/Spouse’s Information
A. Expected 2019 Taxable Income
1. Wages, Salaries, Tips Father $ Student $
Mother $ Spouse $
2. Pension & Annuities $ $
3. Interest/Dividend Income $ $
4. Business or Farm Income $ $
5. Capital Gains $ $
6. Rents Which Will Be Received $ $
7. Alimony $ $
8. Unemployment Compensation $ $
9. Other Taxed Income, $ $
Explain:
B. Expected 2019 Untaxed Income & Benefits
1. Social Security $ $
2. Public Assistance $ $
3. Child Support $ $
4. Housing Allowance $ $
5. Retirement or Disability Benefits $ $
6. Worker's Compensation $ $
7. Payments to Tax-Deferred Pensions $ $
& Savings Plans
(Paid directly or withheld
from earnings
- include 401K & 403B plans)
8. Untaxed Portion of Pension $ $
9. Other Untaxed Income, $ $
Explain:
Total: $ Total: $
U3. SIGNATURE(S)
By signing below, I/We certify that the above information is true and correct to the best of my/our knowledge:
Student Signature Date Student Daytime Phone Number
If Dependent, Parent Signature Date If Independent & Applicable, Spouse’s Signature Date
OFFICE USE ONLY: SPECCO
Ensure that Sections A, B and C are complete and that all of the required supporting documentation is attached
and return this form in person, via mail, fax, or email to finaid@mymail.lccc.edu at your earliest convenience.
Page 3 of 3
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

2019-20 Special Circumstances Appeal Form (Lehigh Carbon Community College)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 4 October 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document