2020-2021 SPECIAL CONDITIONS APPEAL
(2020-2021 Academic Year)
2800 S Lone Tree Rd Flagstaff, AZ 86005-2701 PH: 928-226-4219 FAX: 928-226-4110 email@example.com
FA400-Special Conditions Appeal 20181003
This form is accepted from July 1, 2020 – November 15, 2020 and from *February 1, 2021 – June 30, 2021.
*Students appealing for the 2020 calendar year and are submitting the appeal after November 15, 2020, must submit their
2019 Tax Return Transcripts
and 2019 W-2’s for the Student / Parent / Spouse.
If your financial situation has changed since 2018, you may complete this form to request a FAFSA adjustment for the 2020-21
school year. You may request an adjustment to your income based on your 2019 actual earnings OR your 2020 estimated
earnings. The Financial Aid Office can help you determine which scenario will more accurately reflect your ability to pay for college.
Professional judgment evaluations are made on a case-by-case basis and do not guarantee eligibility for aid. Allow 10 business
days after the financial aid file has been verified for the appeal to be reviewed; if corrections are required during initial
verification, the process will be delayed.
All appeals must include the following documentation:
• A signed and dated statement explaining your appealable situation from both parent(s) and
student. Both must submit
their own signed statement with this completed form. Please be specific and include pertinent details (e.g. what has
changed, why the change occurred, and the dates changes occurred.) The specific details help us to better understand
your particular situation.
• A copy of 2018 Tax Return Transcripts for the student/parent(s)/spouse if the Data Retrieval Option on the FAFSA was
• Copies of all 2018 W-2’s for student/parent(s)/spouse.
• Dependent / Independent Verification Form 2020-2021 (available at CCC website under Financial Aid Forms page)
In the tabl
e below, check the special circumstance that applies to you or your family situation.
of employment or
Your parent(s’) or
your income earned in
2019 or 2020 is less
than that earned in
You (and/or your
earned in 2019 or
2020 is less than
that earned in 2018.
• 2019 W-2’s (Student /Parent/Spouse – only if
appealing to use 2018 income
• 2019 Tax Return Transcript– only if appealing to use
• Final or Most Current Paystub for Student/Parent/
Spouse with Year to Date Earnings – only if appealing
• Termination letter from employer (if applicable)
• Unemployment Benefit Summary (if applicable)
Date of Change:
divorced; or widowed
after the FAFSA was
or widowed after the
FAFSA was filed.
Provide documentation applicable to your situation:
• Copy of Marriage Certificate
• Copy of Divorce decree or legal separation
• Proof of separate residence for both parties
• Copy of Death Certificate (if applicable)
You or your parent(s)
received a one-time
payment (lump sum)
You (and your
spouse) received a
(lump sum) in 2018.
• Write a statement and provided documents detailing
loss of one-time payment.
CCC ID# Last Name First Name MI
Mailing Address City State Zip Code
Telephone No. (include area code) Email Address