Fillable 2020-2021: SPECIAL CONDITIONS APPLICATION (Temple College)

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2020-2021: SPECIAL CONDITIONS APPLICATION (Temple College)

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Revised 10/01/19 SPECIAL CONDITIONS APPLICATION 2020 – 2021 Page 1
2020-2021: SPECIAL CONDITIONS APPLICATION
STUDENT NAME:
STUDENT ID#:
ADDRESS:
CITY, STATE, ZIP:
PHONE NUMBER:
EMAIL:
You must file a 2020-21 FAFSA before completing this form. Typically, the data provided on the Free Application for Federal Student Aid
(FAFSA) is intended to determine the amount your family can reasonably be expected to pay toward your college costs. If your actual 2018
earnings or your estimated 2020 earnings is at least 25% less than the 2018 actual income, you may be eligible for consideration of special
circumstances.
SECTION I: REASON FOR SPECIAL CONDITION REQUEST (Must Complete)
To determine if any adjustments can be made to your financial aid application, please check the box(es) to the left of the reason(s) that best
meets your request for reduction of income and complete the appropriate section(s). You MUST also submit documentation items listed
under the respective reason for your request.
□ Drastic change in earnings or loss of other income: Student/spouse/parent who received income in 2018 lost his/her job and
had a major loss of employment income in 2019 or 2020. This could include a loss of earnings, reduction in earnings, loss of employment
or social security benefits, child support, or other taxed or untaxed income.
Specify whom this circumstance pertains to: Student______ Spouse_____ Father_____ Mother_____
Date reduction/loss occurred: ________________________ (DO NOT LEAVE BLANK)
The following items MUST be presented, but additional documentation may be required:
• Dependent (or Independent) Student Verification Worksheet for 2020-2021 along with a copy of student/spouse’s or
student/parent’s 2018 IRS Tax Return Transcript (if IRS Data Retrieval Tool was not used).
• Student /spouse or student/parent’s final or last pay stub in 2019 from all employers. The pay stub(s) must document year-
to-date earnings.
• For loss of employment: Initial letter from Texas Workforce that includes beginning and ending dates of benefits and the
amount received.
• For proof of job loss: Letter from prior employer stating date of job loss.
• If presently working, a letter from that employer verifying hours per week and salary.
• For untaxed income loss (social security, child support, etc.): Submit verifying documentation.
• Copy of all W-2s from 2018, and a signed copy of student/spouse’s or student/parent’s completed 2018 federal income tax
return if filed.
• After December 31, 2019, you may be required to submit a signed copy of student/spouse’s or student/parent’s completed
2019 federal income tax return, tax schedules and all W-2s.
□ Divorce or legal separation: Since applying for financial aid, you/your parents have become divorced or separated.
Date of divorce/separation: ________________________________ (DO NOT LEAVE BLANK)
The following items MUST be presented, but additional documentation may be required:
• Dependent (or Independent) Student Verification Worksheet for 2020-2021 along with a copy of student/spouse’s or
student/parent’s 2018 IRS Tax Return Transcript (if IRS Data Retrieval Tool was not used).
• You must attach a copy of the divorce decree or the divorce petition verifying separation.
• Copy of all W-2s from 2019, and signed copy of completed 2018 federal income tax return (both if filed separately), if
filed.
• After December 31, 2020, you may be required to submit a signed copy of your completed 2020 federal income tax return
(both if filed separately), tax schedules and all W-2s.
Student’s Name (PRINT): _____________________________________________________ Student ID#: ______________________
Revised 10/01/19 SPECIAL CONDITIONS APPLICATION 2020-2021 Page 2
□ Death of spouse/parent: Since applying for financial aid, your spouse/parent has died.
The following items MUST be presented, but additional documentation may be required:
• Dependent (or Independent) Student Verification Worksheet for 2020-2021 along with a copy of student/spouse’s or
student/parent’s 2018 IRS Tax Return Transcript (if IRS Data Retrieval Tool was not used).
• Copy death certificate.
• Copy of all W-2s from 2019, and a signed copy of student/spouse’s or student/parent’s completed 2019 federal income tax
return if filed.
• After December 31, 2020, you may be required to submit a signed copy of student/spouse’s or student/parent’s completed
2020 federal income tax return, tax schedules and all W-2s.
□ Disability of student/spouse/parent:
Date of Disability: ________________________________ (DO NOT LEAVE BLANK)
The following items MUST be presented, but additional documentation may be required:
• Dependent (or Independent) Student Verification Worksheet for 2020-2021 along with a copy of student/spouse’s or
student/parent’s 2018 IRS Tax Return Transcript (if IRS Data Retrieval Tool was not used).
• Disability certification.
• Copy of all W-2s from 2019, and a signed copy of student/spouse’s or student/parent’s completed 2019 federal income tax
return if filed.
• Evidence of loss of earnings (such as a signed letter from employer on company letterhead).
• After December 31, 2020, you may be required to submit a signed copy of student/spouse’s or student/parent’s completed
2020 federal income tax return, tax schedules and all W-2s.
□ Unusually high medical or dental expenses not covered by insurance: Since applying for financial aid, you or your
parent(s) are experiencing unusually high medical or dental expenses not covered by insurance.
You MUST answer the following questions:
1. How much did you pay for medical/dental insurance in 2018? (Do not include employer’s contribution) $______________
2. What were your total 2018 medical/dental expenses not paid by insurance? $_____________________________________
3. Please explain if your unreimbursed medical/dental expenses will be higher in 2019 or 2020 and why. __________________
____________________________________________________________________________________________________
4. How much do you estimate that you will pay out-of-pocket for medical/dental expenses in 2019 or 2020? ______________
The following items MUST be presented, but additional documentation may be required:
• Dependent (or Independent) Student Verification Worksheet 2020-2021 along with a copy of student/spouse’s or
student/parent’s 2018 IRS Tax Return Transcript (if IRS Data Retrieval Tool was not used).
• Copy of receipts for medical payments NOT covered by insurance from January 2019 through December 2019 or January
2020 through December 2020. Statements must show name of patient(s), dates of charges and amount paid by patient.
• Copy of all W-2s from 2019, and a signed copy of student/spouse’s or student/parent’s completed 2019 federal income tax
return if filed.
• After December 31, 2020, you may be required to submit a signed copy of student/spouse’s or student/parent’s completed
2020 federal income tax return, tax schedules and all W-2s.
The federal formula used to calculate an EFC allows for 11% of a family’s adjusted gross income to be allocated to medical expenses. Only medical expenses in excess of
the 11% may be considered. Medical expenses that were an itemized deduction on the federal income tax return CANNOT be considered for professional judgment
purposes.
□ Elementary or Secondary School Tuition for the Student’s Siblings or Dependents: You or your parent(s) paid
private elementary or secondary school tuition for your siblings or dependents.
The following items MUST be presented, but additional documentation may be required:
• Dependent (or Independent) Student Verification Worksheet for 2020-2021 along with a copy of student/spouse’s or
student/parent’s 2018 IRS Tax Return Transcript (if IRS Data Retrieval Tool was not used).
• Proof of institutional tuition expenses paid out-of-pocket.
Student’s Name (PRINT): _____________________________________________________ Student ID#: ______________________
Revised 10/01/19 SPECIAL CONDITIONS APPLICATION 2020-2021 Page 3
□ 2018 Tax Return included a one-time income amount: You or your parent(s) received an inheritance, lump sum Social
Security payment, a retirement or IRA distribution, or some other nonrecurring payment that was spent or invested.
The following items MUST be presented, but additional documentation may be required:
• Dependent (or Independent) Student Verification Worksheet for 2020-2021 along with a copy of student/spouse’s or
student/parent’s 2018 IRS Tax Return Transcript (if IRS Data Retrieval Tool was not used).
• Official documentation that identifies source of income (legal forms, financial statements, etc.)
• Documentation of how the funds were spent or invested and why they are not available as a resource.
□ Other: The student can specifically identify another reasonable circumstance, which would substantiate a reduction in income for 2019
or 2020.
The following items MUST be presented, but additional documentation may be required:
• Dependent (or Independent) Student Verification Worksheet for 2020-2021 along with a copy of student/spouse’s or
student/parent’s 2018 IRS Tax Return Transcript (if IRS Data Retrieval Tool was not used).
• Sufficient documentation verifying your circumstance.
SECTION II: STUDENT / FAMILY INCOME (Must Complete)
Before an adjustment can be made to your status, you must provide complete information regarding the change in 2018 financial circumstances for you or
your parents. Please provide the best possible estimates for the period of 01/01/2018 to 12/31/2018 OR 01/01/2019 to 12/31/2019 as applicable. The
Financial Aid Office can help you determine which year will more accurately reflect your ability to pay for college in 2018-2019. After receiving this form
and the required documents, we may ask you for further documentation.
The Amounts You Are Reporting on This Form are… (choose only one)
2019 Actual Earnings
2020 Estimated Earnings
Report the Yearly Amounts
2019 or 2020 Taxable Income:
Student
Spouse
Parent(s)
How much will be earned from work?
$
$
$
How much will be received in severance compensation?
$
$
$
How much will be received in unemployment benefits?
$
$
$
Other type of taxable income: ________________________
$
$
$
Other type of taxable income: ________________________
$
$
$
2019 or 2020 Untaxed Income:
How much will be received in Social Security benefits?
$
$
$
How much will be received in Worker's Compensation?
$
$
$
How much will be received in child support for all children?
$
$
$
Other type of untaxed income: ________________________
$
$
$
Other type of untaxed income: ________________________
$
$
$
Student’s Name (PRINT): _____________________________________________________ Student ID#: ______________________
Revised 10/01/19 SPECIAL CONDITIONS APPLICATION 2020-2021 Page 4
SECTION III: CERTIFICATION & SIGNATURE REQUIREMENTS (Must Complete)
ADDITIONAL STUDENT COMMENTS: _____________________________________________________________________________
CERTIFICATION: I certify that to the best of my knowledge all of the information provided on this form and all attached documents is true
and complete. If asked by an authorized official I agree to give proof of the information that I have given on this form. I realize that if I do not
give proof when asked this request may not be processed for financial aid.
Student’s Signature: __________________________________________________ Date: ________________
Parent’s Signature: ___________________________________________________ Date: ________________
Please complete and return this form and the Verification Worksheet along with ALL supporting documentation to Temple College,
Financial Aid Office, 2600 South First Street, Temple, TX 76504. Incomplete applications will not be processed.
FOR OFFICE USE ONLY
Is there a prior year Special Conditions processed? Yes ___ No ___ Pell LEU: ____% Pell % used CY: ___% SULA: ___
Special Conditions decision: Approved __________ Denied __________ Will not benefit __________
Reason for Approval / Denial: ___________________________________________________________________________________
___________________________________________________________________________________________________________
Data elements reduced or changed on the FAFSA: __________________________________________________________________
Old EFC: _______________ New EFC: _______________
Financial Aid Administrator’s signature/Title: __________________________________________________ Date: _______________
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2020-2021: SPECIAL CONDITIONS APPLICATION (Temple College)

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Completed 27 July 2020

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