PURPOSE: According to federal laws, a family’s 2017 income is used to assess financial need for the 2019-2020 aid year. If the family’s 2019
calendar year income is lower due to a special circumstance, a financial aid administrator may be able to use the 2019 income to assess financial
need. Please complete this form to assist you in reporting changes in the financial circumstances of you and/or your spouse that have occurred and
that will severely limit the ability of your and/or your spouse to contribute toward your 2019-2020 college costs.
IF THIS FORM IS NOT FILLED OUT COMPLETELY AND IF ALL THE INFORMATION IS NOT SUBMITTED THIS FORM WILL
NOT BE PROCESSED. If this form is submitted after January 1, 2020, a 2019 tax transcript and W-2s must be attached.
Please check the categories that apply to the student/spouse and complete the Expected Income and Benefits Table.
Unemployment or change of employment: Student/Spouse must have earned money in 2017 and lost his/her job involuntarily
for at least eight weeks in 2019.
Required Documentation
A signed copy of your and/or your spouse’s 2017 IRS Federal Tax Return and W-2’s and a copy of your 2017 IRS tax transcript if they did not
use the IRS retrieval on the FAFSA.
A signed copy of your and/or your spouse’s 2018 IRS Federal Tax Return and W-2’s and a copy of your 2018 IRS tax transcript
Submit a copy of the letter of separation/termination or letter from your previous employer on company letterhead stating effective date and the
circumstances under which you or your spouse left their employment.
Last or current paycheck stub showing 2019 year-to-date earnings for both student and spouse from each job worked in 2019.
Unemployment benefit summary stating the last day worked
Verification of unemployment and amounts of unemployment benefits received
Verification of disability and amount of benefits received.
Death of a spouse
Required Documentation
Copy of death certificate
A signed copy of your and/or your spouse’s 2017 IRS Federal Tax Return and W-2’s and a copy of your 2017 IRS tax transcript if you did not
use the IRS retrieval on the FAFSA.
A signed copy of your and/or your spouse’s 2018 IRS Federal Tax Return and W-2’s and a copy of your 2018 IRS tax transcript
You and your spouse have separated or divorced.
Required Documentation
Copy of separation or divorce decree (indicating date of separation/divorce), if legal documentation cannot be provided, student must submit a
signed statement with the details of separation living arrangements and date of separation.
A signed copy of your and/or your spouse’s 2017 IRS Federal Tax Return and W-2’s and a copy of your 2017 IRS tax transcript if you did not
use the IRS retrieval on the FAFSA.
A signed copy of your and/or your spouse’s 2018 IRS Federal Tax Return and W-2’s and a copy of your 2018 IRS tax transcript
Medical and dental expenses that exceed 12% of your total income
Required Documentation
2017 1040 Schedule A
Provide copies of cancelled checks or paid receipts for expenses paid in 2017 that were not reimbursed by insurance.
A signed copy of your and/or your spouse’s 2017 IRS Federal Tax Return and W-2’s and a copy of your 2017 IRS tax transcript if you did not
use the IRS retrieval on the FAFSA.
A situation you feel warrants consideration for special circumstances (loss of a benefit; e.g. child support, social security for a
surviving dependent, unemployment, disability, workers’ comp, or other)
Required Documentation
Provide written explanation and supporting documentation
A signed copy of your and/or your spouse’s 2017 IRS Federal Tax Return and W-2’s and a copy of your 2017 IRS tax transcript if you did not
use the IRS retrieval on the FAFSA.
A signed copy of your and/or your spouse’s 2018 IRS Federal Tax Return and W-2’s and a copy of your 2018 IRS tax transcript.
