2019-2020 STUDENT REVIEW
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STUDENT NAME BRANDMAN ID NUMBER
You may request reconsideration of your financial aid award if your financial circumstances have changed
significantly or you have special circumstances that were not reported on your initial financial aid application.
Changes resulting from this review do not guarantee an increase in aid.
What is the change in circumstances? (check all that apply)
Termination of employment or other
employment change
Retirement
Disability
Loss of untaxed income (e.g., child support,
Social Security, unemployment benefits)
Recent separation/divorce
Unusual medical/dental bills
Expenses associated with the care of an
elderly parent or grandparent
Child care expenses
Accessibility expenses
Other circumstances (explain in personal
statement)
Supporting documentation included (check all that apply)
Termination/severance letter
Most recent paystub showing new/changed salary
Final paystub from previous employer
Statement of unemployment benefits
2018 federal income tax return
Copy of medical/dental bills showing unreimbursed expenses
Statement of disability benefits
Child care expense receipts
Other: _____________________________________________________
Attach a personal statement
You must attach a personal statement explaining the circumstances on which your review request is based and their
effect on your or your family’s ability to contribute toward your education costs. Please provide as much detail as
possible to help us better understand your financial situation.
Substantial changes in 2018 and/or 2019 income
If your review request is based on a substantial change to income in 2018:
- Include a copy of your 2018 federal tax return along with your documentation.
If your review request is based on a substantial change to your income in 2019:
- Itemize below all sources of income, both taxed and untaxed, that you expect to receive in 2019. Use pre-tax
income figures and include a number for each item; if the amount is zero, put $0.
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Anticipated 2019 income source 2019 pre-tax amount:
Student’s wages, salaries, tips
$
Spouse’s wages, salaries, tips
$
Interest income or dividends
$
Alimony received
$
Net income from business or farm
$
Net rental income (or loss)
$
Pensions, annuities, royalties, partnerships, estates, trusts, etc.
$
IRA distributions
$
Capital gains (or losses)
$
Unemployment compensation, severance pay, etc.
$
Other taxable income (specify sources: )
$
Child support received
$
Contribution to tax-deferred retirement plans (401k, 403b, etc.)
$
Untaxed disability income or Social Security Income
$
Other untaxed income (specify sources: )
$
TOTAL:
$
I CERTIFY THE SUBMITTED INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. I
HAVE READ EACH SECTION AND HAVE PROVIDED THE REQUIRED DOCUMENTATION. I UNDERSTAND THAT
UNDERESTIMATING PROJECTED INCOME COULD RESULT IN REDUCED ELIGIBILITY AND/OR REPAYMENT OF AID AND/OR
DENIAL OF FUTURE REVIEWS/APPEALS.
STUDENT SIGNATURE DATE
Submit completed form with supporting documents via the Student Portal or by:
Fax: 866-659-1147
Mail: Brandman University, Financial Aid Office, Third Floor 16355 Laguna Canyon Rd, Irvine, CA 92618
click to sign
signature
click to edit
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