Fillable 20190424 Special Circumstances Undergraduate Independent (University of Saint Thomas)

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20190424 Special Circumstances Undergraduate Independent (University of Saint Thomas)

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PRIVATE TUITION EXPENSES AT ELEMENTARY OR SECONDARY SCHOOL
Attach a copy of the tuition statement for either the 2017-18 or 2018-19 school year, outlining costs and financial aid awarded,
for each dependent child attending private elementary or secondary school (do not include expenses for any child who will be
enrolling in college in 2019-2020).
If you are divorced, and the non-custodial parent provides assistance toward the private tuition at the elementary or secondary
school(s), provide a statement indicating the amount of assistance.
SPOUSE’S PERSONAL COLLEGE LOAN PAYMENTS
Attach a written statement indicating the college loans your spouse is repaying, and a copy of your spouse’s billing statement
or payment coupon. Include only the loans your spouse has borrowed for his/her own educational expenses and the monthly
amount due. Be sure to total all loan payments after they are detailed.
According to federal laws and regulations, a family’s 2017 income is used to assess financial need for the 2019-2020 school year.
If a family’s 2018 income is lower, due to special circumstances, a financial aid administrator may be able to use 2018 income to
assess financial need. Your special circumstance application will be returned if all requested information outlined is not provided.
Special circumstances, if accepted, may result in an increase in need-based loans, student employment, or in certain cases,
additional grant assistance. Processing time for special circumstance appeals is typically 2-4 weeks.
2019-2020 Special Circumstance Application
for Independent Undergraduate Students
First Name M.I.Last Name
Phone Number
E-mail Address
Permanent Street Address City State Zip Code
ID Number
FINA 1081 10/18
DEATH OF SPOUSE
Please provide a written statement indicating date of death.
DIVORCE OR SEPARATION OF STUDENT AND SPOUSE
Attach a copy of the divorce decree or proof of separation (e.g., court order, statement from attorney or clergy).
If you have children, attach a written statement identifying the custodial parent. Also provide the names, ages, and the
relationship of any family members that the custodial parent will support through June 30, 2020.
Indicate the amount, if any, your former spouse will/has provide(d) toward your college costs at St. Thomas for the 2019-2020
school year. $___________
Student Information
SECTION 2: EDUCATIONAL EXPENSES
Return this form, with attachments, to:
University of St. Thomas
Financial Aid Office, Mail 5007
2115 Summit Avenue, St. Paul, MN 55105-1096
651-962-6550 or 1-800-328-6819, Ext. 2-6550 / Fax: 651-962-6599
SECTION 1: CHANGE IN HOUSEHOLD SIZE that occurred after filing your FAFSA
Check this box if you have already provided our office with a copy of your 2017 federal tax return transcript or
used the IRS Data Retrieval Tool to transfer 2017 tax data to the FAFSA.
ATTENTION: Regardless of your particular situation, all Special Circumstances Applications must include a copy of
your 2017 federal tax return transcript, and W-2 statements for you and your spouse (if applicable). Please include
Schedule A from your federal tax return if you itemize your deductions.
OVER
REQUIRED ITEMS
Regardless of the cause of the income loss, all applications must include:
A written statement explaining the cause, approximate start date, and expected duration of the loss of income. Please provide
any details that will help our staff understand how your financial situation has changed.
A complete Income Source Table (below). Be sure to include all income sources and provide written notes if the receipt of
projected income is uncertain in amount or dependent on other factors.
Student’s and/or spouse’s most recent paystubs (2 minimum) from all employers (if applicable). Please indicate on the paystub
the length of the pay period (e.g. weekly, bi-weekly, monthly).
Failure to provide any of the above items will delay the processing of your request.
SECONDARY DOCUMENTATION
Please provide a photocopy of additional documentation where appropriate. Some examples include but are not limited to:
• Unemployment benefits summary received from the state job service office
• A letter from a physician detailing a disability and prognosis
• A lay-off notice from an employer or details of a severance package
• A notice regarding bankruptcy or foreclosure of a family business/farm
CHANGES TO INCOME INELIGIBLE FOR REVIEW
In general, we do not consider changes to income due to loss of overtime, one-time bonuses, withdrawal from retirement accounts,
or gambling winnings or losses.
2018 Actual: 2019 Estimated:
Student/Spouse Income Source Table
Spouse gross earnings from work (wages, salary, tips, etc.)*
Business/Farm Income
Interest/Dividend Income. Specify source and value:
________________________________ $ ________________
Unemployment Compensation
Capital Gains
Spousal Maintenance
Child Support
Taxable Social Security Benefits
Worker’s Compensation
Short-term or Long-term Disability Benefits
Severance Pay
Withdrawal from retirement account
Other Income (pension, annuity, rental income, housing
allowance, bonuses, etc.)
Student gross earnings from work (wages, salary, tips, etc.)*
SECTION 4: REDUCTION IN EARNINGS OR LOSS OF OTHER INCOME
*Attach most recent paystub(s) for you and your spouse when submitting your appeal.
Section 5: Sign this Worksheet
By signing this worksheet, I certify that all the information reported on it is complete and correct. WARNING: If you purposely give false or
misleading information on this worksheet, you may be fined, sentenced to jail, or both.
Student Signature Date
X
Provide a signed statement itemizing 2017 or 2018 out-of-pocket medical, dental and dependent care expenses you paid
(not reimbursed by insurance or by employer’s pre-tax cafeteria plan) for health/dental insurance premiums, doctor, hospital,
medication,
dependent care, nursing home expenses, etc. Please total all expenses after they are detailed.
SECTION 3: MEDICAL/DENTAL/DEPENDENT CARE EXPENSES not reimbursed or covered by insurance
$0.00
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20190424 Special Circumstances Undergraduate Independent (University of Saint Thomas)

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Completed 23 July 2020

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