Fillable 2020-2021 SPECIAL CONDITIONS APPEAL (Coconino Community College)

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2020-2021 SPECIAL CONDITIONS APPEAL (Coconino Community College)

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SPECON
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 finaid@coconino.edu
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
not used.
• 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.
Special
Circumstance
Dependent
Students
Independent
Students
Additional Required
Documentation
Reduction or loss
of employment or
untaxed benefits
Your parent(s’) or
your income earned in
2019 or 2020 is less
than that earned in
2018.
You (and/or your
spouse’s) income
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
2018 income
• Final or Most Current Paystub for Student/Parent/
Spouse with Year to Date Earnings – only if appealing
2019 income
• Termination letter from employer (if applicable)
• Unemployment Benefit Summary (if applicable)
Change in marital
status
Date of Change:
Your parents were
married; separated;
divorced; or widowed
after the FAFSA was
filed.
You were married;
separated; divorced
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)
One time
payment
received
You or your parent(s)
received a one-time
payment (lump sum)
in 2018.
You (and your
spouse) received a
one-time payment
(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
SPECON
FA400-Special Conditions Appeal 20200414
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 finaid@coconino.edu
Before an adjustment can be made to your status, you must provide complete information regarding the change in 2018
financial circumstances for you, you and your spouse you and your parents. Please provide the actual amounts for 1/1/20
to 12/31/20 or the best possible estimates for 1/1/20 to 12/31/20. During the processing of this appeal, we may request
additional documentation from y
ou, your spouse or your parent.
I am asking for an adjustment to my FAFSA based on income/information from the:
⃝
⃝
2019 – You will list actual earnings received in 2019 from 2019 W-2’s and/or 201
9 Tax Return Transcript.
2020 – You will list actual and estimated earnings received from January 1, 2020 to December 31, 2020.
List Yearly Amounts Below
2019 or 2020 Taxable income Student Spouse Parent 1 Parent 2
Actual earned income from 1/1/2020 - today
$
$
$
Estimated income from today – 12/31/2020
$
$
$
TOTAL earned and
estimated income for 2020
$
$
$
Unemployment Benefits
$
$
$
Business / Farm Income (Loss)
$
$
$
Veterans Non-Educational Benefits
$
$
$
Other Taxable Income (Severance pay,
Alimony, Capital Gains, etc.)
List Source:
$
$
$
Other Taxable Income (Severance pay,
Alimony, Capital Gains, etc.)
List Source:
$
$
$
2019 or 2020 Untaxed income Student Spouse Parent 1 Parent 2
Disability / Worker’s Compensation
$
$
$
Child Support Received
$
$
$
Other Non-Taxable Income
List Source:
$
$
$
Other Non-Taxable Income
List Source:
$
$
$
Requests will be denied if all required documentation is not submitted. Please ensure you have submitted all required
documentation with this appeal form.
I certify that information provided on this form is true and complete to the best of my knowledge. Purposely
giving false or misleading information may result in a delay or denial of my federal financial aid and I may be
fined up to $20,000, sent to prison or both. I hereby provide consent for the use of electronic records and
signatures on all financial aid documents. I understand that if I choose to sign electronically, my electronic
signature constitutes a binding contract and may not be denied legal effect, validity, or enforceability solely
because it is in electronic form or because an electronic signature or electronic record was used in its formation.
Student Signature and Date How do I create a digital signature with Adobe?
Parent Signature and Date (Required for Dependent Students)
Must be signed and mailed to CCC.
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2020-2021 SPECIAL CONDITIONS APPEAL (Coconino Community College)

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Completed 25 July 2020

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