T:\Forms\2021\Revision Request Form-2021-Student.docx
Instructions: We may be able to use your projected resources for the 2020/2021 school year (07/01/20-06/30/21)
instead of the actual resources from the 2018 tax year to determine your family contribution. Read and fill out each
section carefully to prevent errors. Complete ALL sections. Incomplete forms will be returned to you for completion.
***Please note that this form is NOT used for requesting additional student expense consideration. That form is titled
“Additional Expense Request for Students”. If you are a Dependent student and wish to report changes in your parent
circumstances, please have them fill out the PARENT Revision Request form.***
RETURN FORM TO: Financial Aid Office 1300 Fifth Street – Wenatchi Hall Wenatchee, WA 98801 Fax: 509-682-6811
Read and fill out each section carefully to prevent errors. Complete ALL sections. Steps: 1) In Section B, indicate the type
of change. 2) In Section C, check all appropriate boxes. No amounts are required. 3) In Section D, complete BOTH
columns of the Worksheet. Use whole dollar amounts, no cents. If you are currently married and not separated, provide
BOTH your and your spouse’s income information. Where the question does not apply, or the answer is “none”, enter
zero. Leaving blanks may delay the processing of your request. Questions? 509-682-6810 or email@example.com
USection B:U TYPE OF CHANGE (please check and complete all appropriate selections)
UPERMANENTU CHANGE IN STUDENT MARITAL STATUS, requesting to exclude spouse income/information.
If a permanent change has occurred since the FAFSA (or WASFA) was filled out and a spouse’s income is no
longer available, we may be able to recalculate using just your information, and excluding your spouse’s information.
1. Type of marital status change: ___ widowed ___ separated ___ divorced
2. Date of marital status change: ___________
3. Spouse Name: _____________________________ Spouse SS# _______ - ______ - ________
4. Spouse is a WVC student Yes No
DECREASE IN STUDENT AND/OR SPOUSE EARNED INCOME
1. Date of income change: ___________ Decrease is for ___ Student ___ Spouse (complete Spouse info above)
2. Income change is due to: ___ Loss of Job ___ Reduced hours ___ Job Change ___ Retired ___ Loss of
Unemployment Benefits ___ Other (explain: ___________________________________________________)
3. Did you, or will you, (or Spouse) receive Unemployment Benefits during the time period 07/01/20-06/30/21?
___ YES ___ NO (*** if yes, report GROSS amounts in Section D, Category 1)
OTHER CIRCUMSTANCES: Attach a separate signed letter explaining how your ability to contribute has been
affected. Include any supporting documentation. We will notify you if we need additional information.
UMUST COMPLETE SECTION C & D ON THE OTHER SIDE OF THE FORM
Section A: STUDENT INFORMATION (please print)
_______________________________________ _____________________ ___
*SID FIELD (BELOW) IS REQUIRED*
__________________________________________ _____/______/______ SID:
_______ ______ ________
Address (include apt # if applicable)
(______) ______ _______
Daytime Phone (include area code)
I certify that all information provided on this form is true and complete to the best of my knowledge. If an adjustment is granted based on estimated
e, I agree to report any increase in that income to the Financial Aid office.
*If electronically signed, I understand that a digital or electronic typed
signature has the same legal effect, and can be enforced in the same way, as a written signature. *
Student Signature __________________________________________ Date ________________
DUE TO DECREASE IN RESOURCES OF STUDENT OR SPOUSE
*Print/Save & Clear buttons
are at bottom of 2nd page*