Fillable 2019-2020 Special Circumstances Appeal Independent Student (Eastern Florida State College)

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2019-2020 Special Circumstances Appeal Independent Student (Eastern Florida State College)

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EFSC Office of Financial Aid
www.easternflorida.edu/go/aid | (321) 433-7339 | finaid@easternflorida.edu
1 04/16/19
SPECL
FA Professional
Judgement
2019-2020 Special Circumstances Appeal
Independent Student
The Office of Financial Aid recognizes that students may experience a change in their financial situations after the Free
Application for Federal Student Aid (FAFSA) has been filed. You should use this form only if you have experienced a
significant change in income, have unusual medical or dental expenses, or have other unusual circumstances and wish to
request special consideration of these items.
A. Student Information
B#
Last Name First Name M.I. Student ID
B. Required Documentation
The chart below shows which documentation must be submitted to demonstrate special circumstances. If for any
reason the required documentation is not available, include a written explanation of why it is not available.
Loss of Income – Student
and/or Spouse
1. Typed, signed letter explaining the change in circumstances. Include when
the change occurred and your current financial situation.
2. Letter of termination.
3. Unemployment determination letter.
4. Final paystub.
5. Signed copy of 2017 Form 1040 filed with the IRS or 2017 IRS Tax Transcript,
if not already submitted during the verification process
.
6. Signed copy of 2018 Form 1040 filed with the IRS or 2018 IRS Tax Transcript.
7. If this form is filed after January 1, 2020, signed copies of your and your
spouse’s 2019 income tax return(s) must be attached.
Reduction of Income –
Student and/or Spouse
1. Typed, signed letter explaining the change in circumstances. Include when
the change occurred and your current financial situation.
2. All current paystubs.
3. Signed copy of 2017 Form 1040 filed with the IRS or 2017 IRS Tax Transcript,
if not already submitted during the verification process
.
4. S
igned copy of 2018 Form 1040 filed with the IRS or 2018 IRS Tax Transcript.
5. If this form is filed after January 1, 2020, signed copies of your and your
spouse’s 2019 income tax return(s) must be attached.
EFSC Office of Financial Aid
www.easternflorida.edu/go/aid | (321) 433-7339 | finaid@easternflorida.edu
2
Change in Marital Status
1. Typed, signed letter explaining the change in circumstances. Include when
the change occurred and your current financial situation.
2. Divorce decree or separation agreement.
3. Child support or alimony agreement.
4. All current paystubs.
5. Signed copy of 2017 Form 1040 filed with the IRS or 2017 IRS Tax Transcript,
if not already submitted during the verification process.
6. Signed copy of 2018 Form 1040 filed with the IRS or 2018 IRS Tax Transcript.
7. All W-2s for 2017 and 2018 if you a filed joint return.
8. If this form is filed after January 1, 2020, signed copies of your 2019 income
tax return(s) must be attached.
Excessive Medical
Expenses – Exceeds 11% of
your income. Cannot
include charges covered by
insurance.
1. Typed, signed letter explaining the change in circumstances. Include when
the change occurred and your current financial situation.
2. Documentation of medical expenses.
3. Signed copy of 2017 Form 1040 filed with the IRS or 2017 IRS Tax Transcript,
if not already submitted during the verification process.
4. Signed copy of 2018 Form 1040 filed with the IRS or 2018 IRS Tax Transcript.
5. If this form is filed after January 1, 2020, signed copies of your and your
spouse’s 2019 income tax return(s) must be attached.
Death of Spouse
1. Typed, signed letter explaining the change in circumstances. Include when
the change occurred and your current financial situation.
2. Signed copy of 2017 Form 1040 filed with the IRS or 2017 IRS Tax Transcript,
if not already submitted during the verification process.
3. Signed copy of 2018 Form 1040 filed with the IRS or 2018 IRS Tax Transcript.
4. Death certificate.
5. Documentation regarding any proceeds you have received or expect to
receive from your spouse’s estate, including inheritance, insurance,
pensions, Social Security, etc.
6. If this form is filed after January 1, 2020, signed copies of your and your
spouse’s 2019 income tax return(s) must be attached.
Loss of Untaxed Income
1. Typed, signed letter explaining the change in circumstances. Include when
the change occurred and your current financial situation.
2. Official documentation terminating the untaxed income.
3. Signed copy of 2017 Form 1040 filed with the IRS or 2017 IRS Tax Transcript,
if not already submitted during the verification process.
4. Signed copy of 2018 Form 1040 filed with the IRS or 2018 IRS Tax Transcript.
5. If this form is filed after January 1, 2020, signed copies of your and your
spouse’s 2019 income tax return(s) must be attached.
One Time Income –
Inheritance, lottery
income, IRA or pension
distribution, moving
expenses allowance
1. Typed, signed letter explaining the change in circumstances. Include when
the change occurred and your current financial situation.
2. Corresponding documentation.
3. Signed copy of 2017 Form 1040 filed with the IRS or 2017 IRS Tax Transcript,
if not already submitted during the verification process.
4. Signed copy of 2018 Form 1040 filed with the IRS or 2018 IRS Tax Transcript.
5. If this form is filed after January 1, 2020, signed copies of your and your
spouse’s 2019 income tax return(s) must be attached.
EFSC Office of Financial Aid
www.easternflorida.edu/go/aid | (321) 433-7339 | finaid@easternflorida.edu
3
Other
1. Typed, signed letter explaining the change in circumstances. Include when
the change occurred and your current financial situation.
2. Corresponding documentation.
3. Signed copy of 2017 Form 1040 filed with the IRS or 2017 IRS Tax Transcript,
if not already submitted during the verification process.
4. Signed copy of 2018 Form 1040 filed with the IRS or 2018 IRS Tax Transcript.
5. If this form is filed after January 1, 2020, signed copies of your and your
spouse’s 2019 income tax return(s) must be attached.
C. Estimated Income for Calendar Year 2019
Type of Income Student Spouse
Income from Work (wages, salary, tips, severance pay, etc.)
Other Taxable Income (unemployment, pension etc.)
Untaxed Social Security Benefits
Child Support/Alimony Received
In kind support from family or friends (someone paying bills in your name)
TOTAL
Please Note: If this form is filed after January 1, 2020, signed copies of your and your spouse’s 2019 income
tax return(s) must be attached.
D. Household Information
List below the people in your household. Include:
• Yourself.
• Your spouse, if you are married.
• Your children or spouse’s children, if any, if you or your spouse will provide more than half of the children’s
support from July 1, 2019, through June 30, 2020, even if the child does not live with you.
• Other people if they now live with you and you provide more than half of the other person’s support and
will continue to provide more than half of that person’s support through June 30, 2020.
Full Name
Age
College
(Enter only if household member will
be attending at least ½ time)
Will be
Enrolled at
Least ½ Time
Self Eastern Florida State College Yes
EFSC Office of Financial Aid
www.easternflorida.edu/go/aid | (321) 433-7339 | finaid@easternflorida.edu
4
E. Certification and Signature
By signing below I certify that all of the information reported is
complete and correct.
Student’s Signature Date
F. Document Submission
You may submit this document by the following methods:
1. EFSC DOCUMENT DROPBOX (RECOMMENDED)
Print and complete this document (including the original signatures), scan the document, and upload the
document via the Document Dropbox in myEFSC. Printers and scanners are available in EFSC’s open
computer labs and libraries.
2. IN PERSON
Submit your document in person at the Office of Financial Aid on any campus:
Cocoa
Building 11, Room 209
Monday through Thursday, 8 a.m. to 7 p.m.
Palm Bay
Building 1, Room 117
Monday through Thursday, 8 a.m. to 7 p.m.
Melbourne
Building 1, Room 137
Monday through Thursday, 8 a.m. to 7 p.m.
Titusville
Building 3, Room 125
Monday through Wednesday, 8 a.m. to 5:30 p.m.
Thursday, 8 a.m. to 7 p.m.
3. BY MAIL
Mail your document to the Office of Financial Aid on any campus:
Cocoa
Eastern Florida State College
Office of Financial Aid, C11-209
1519 Clearlake Road
Cocoa, FL 32922
Palm Bay
Eastern Florida State College
Office of Financial Aid, PB1-117
250 Community College Parkway
Palm Bay, FL 32909
Melbourne
Eastern Florida State College
Office of Financial Aid, M1-137
3865 N. Wickham Road
Melbourne, FL 32935
Titusville
Eastern Florida State College
Office of Financial Aid, T3-125
1311 N. US 1
Titusville, FL 32976
QUESTIONS?
Financial Aid Specialists are available at the campus locations listed above, by phone at 321-433-7339, and via e-mail at
finaid@easternflorida.edu.
Eastern Florida State College is committed to equal access/equal opportunity in its programs, activities, and employment. For
additional information, visit Eastern Florida State College:
easternflorida.edu/go/equity.
WARNING: If you purposely give false
or misleading information, you may be
fined, sent to prison, or both.
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2019-2020 Special Circumstances Appeal Independent Student (Eastern Florida State College)

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Completed 21 July 2020

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