Fillable 2019-2020 Income Reduction Form-Dependent 2 Fillable

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2019-2020 Income Reduction Form-Dependent 2 Fillable

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The 2019-2020 Income Reduction Form-Dependent 2 Fillable form is 2 pages long and contains:

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  • 4 check-boxes
  • 81 other fields

Country of origin: US
File type: PDF

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2019-2020 Income Reduction Request Page 1 of 2 INREDUC
The Financial Aid Office realizes that some students and their families may have a special circumstance that cause a substantial
reduction in their income that impacts their ability to contribute to college costs.
If you and/or your parents experienced one of the special circumstances outlined below, you may request re-evaluation of your
financial need based on 2018 income instead of 2017. You may appeal one time only. Complete this form ONLY if you and/or your
parents’ financial resources are SUBSTANTIALLY LOWER in 2018 than it was in 2017.
Complete all sections A, B, C, D and attach all requested and supporting documentation. An incomplete appeal will be denied.
A. REASON FOR REQUEST
SPECIAL CIRCUMSTANCE
SUPPORTING DOCUMENTATION REQUIRED
DEATH OF PARENT
Your parent worked in 2017 and their income was reported on the
FAFSA, but is now deceased.
•
Copy of death certificate or equivalent
• Proof of income generated by the deceased individual after
12/31/18
SEPARATION OR DIVORCE
Your parents have become separated or divorced since filing 2017 taxes.
•
Copy of the divorce decree, and/or proof of separate
domiciles.
UNEMPLOYMENT OR CHANGE IN EMPLOYMENT
You and/or your parent(s) earned money and have lost this source of
income since filing the FAFSA.
You and/or your parent(s) worked full time and are no longer working
full time now, and/or suffered a reduction in hours or reduced wages.
•
Copy of most recent pay stubs showing YTD earnings for all
jobs held within the last 12 months
• Letter of Unemployment Insurance Claim Information or
other documentation showing unemployment benefits
dates, amount received, and benefits remaining
• Letter from employer (company letterhead) stating the
cause for change in hours or employment status.
DISABILITY
You and/or your parent(s) experienced difficulty earning income due to
a recent and/or unanticipated disability.
•
Proof of disability
• Proof of YTD earnings
LOSS OF BENEFITS OR NON-RECURRING INCOME
You and/or your parent(s) received income in 2017 (such as inheritance,
early withdrawal of Pension/401K/IRA, Social Security or Child Support)
that is not typical or expected to be received after 12/31/18.
•
Copy of 2017 IRS tax document that reflects the source of
income (IRS form 1040, 1099, etc.)
To request a copy of your *Federal IRS Tax Return Transcript, Wage Statement, OR Verification of Non-Filing Letter
call the IRS at 1-800-908-9946 or go to http://www.irs.gov/individuals/Order-a-Transcript
B. VERIFICATION
In addition to the items requested above for your specific circumstance, please provide each of the following:
ADDITIONAL DOCUMENTATION REQUIRED
1 Detailed letter outlining your and/or your family’s situation and the impact on your 2018 household’s income
2 2019-2020 Student & Parent Income Verification Forms Available on our website www.msjc.edu
3 2019-2020 Household Verification Form Available on our website www.msjc.edu
4
2017 Federal IRS Tax Return Transcripts* and all W-2s for student & parent(s)
If filed a 2017 Federal Tax Return
2017 Verification of Non-Filing* and all 2017 W-2s (if worked) for student & parent(s) If did not file a 2017 Federal Tax Return
5
2018 Federal IRS Tax Return Transcripts* and all W-2s for student & parent(s) If filed a 2018 Federal Tax Return
2018 Verification of Non-Filing* and all 2018 W-2s (if worked) for student & parent(s) If did not file a 2018 Federal Tax Return
2019-2020 INCOME REDUCTION REQUEST (DEPENDENT)
STUDENT INFORMATION
Please PRINT clearly with black/blue ink
Last Name
M.I
Student ID Number
2019-2020 Income Reduction Request Page 2 of 2 INREDUC
A submission of this appeal form does not guarantee an increase in your financial aid award. The change in your financial
resources must be substantial. (Both student and parent(s) income information will be re-evaluated)
C. 2017 & 2018 YEAR INCOME COMPARISON
Indicate the 2017 & 2018 year income (received from January 1st to December 31st) for you and your parent(s). Attach all
appropriate documentation to verify your income.
Type of Income
Dependent Student
2017 Year Amount
Dependent Student
2018 Year Amount
Date
Change Occurred
Mother
Father
Student
Mother
Father
Student
Wages, Tips, Salary $ $ $ $ $ $
Retirement Benefits $ $ $ $ $ $
Disability Benefits $ $ $ $ $ $
Unemployment
Benefits
$ $ $ $ $ $
Social Security Benefits $ $ $ $ $ $
TANF/CAL WORKS
Benefits
$ $ $ $ $ $
Alimony $ $ $ $ $ $
Child Support Received $ $ $ $ $ $
Other (specify) $ $ $ $ $ $
Total Income $ $ $ $ $ $
D. CERTIFICATION
I/WE HEREBY CERTIFY THAT ALL INFORMATION REPORTED ON THIS FORM AND ANY ATTACHMENTS HERETO ARE TRUE, COMPLETE
AND ACCURATE. FALSE INFORMATION OR MISREPRESENTATION WILL BE CAUSE FOR DENIAL, REDUCTION, WITHDRAWAL, AND/OR
REPAYMENT OF FINANCIAL AID.
__________________________________________________________________ _____________________________
Student’s Signature Date
__________________________________________________________________ _____________________________
Parent’s Signature (Required) Date
FINANCIAL AID OFFICE USE ONLY
Request Status:
Trans.#:
Denied
Approved (If already awarded, a revised award notification will be issued within 3-4 weeks.)
New EFC:
FA Signature: Date:
Comments:
2019-2020 INCOME REDUCTION REQUEST (DEPENDENT)
STUDENT INFORMATION
Please PRINT clearly with black/blue ink
Last Name
M.I
Student ID Number
SJC Financial Aid Office * 1499 N State Street * San Jacinto, CA 92583 * Telephone: (951) 487-3245
MVC Financial Aid Office * 28237 La Piedra Road * Menifee, CA 92584 * Telephone: (951) 639-5245
Email: finaid@msjc.edu * Website: www.msjc.edu
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2019-2020 Income Reduction Form-Dependent 2 Fillable

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Completed 6 December 2019

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