Fillable 2020-2021 Special Circumstance Request Financial Aid Offices (Woodland Community College)

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2020-2021 Special Circumstance Request Financial Aid Offices (Woodland Community College)

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The 2020-2021 Special Circumstance Request Financial Aid Offices (Woodland Community College) form is 5 pages long and contains:

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  • 10 check-boxes
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Country of origin: US
File type: PDF

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Yuba Community College District
Financial Aid Offices
Yuba College
2088 North Beale Road
Marysville, CA 95901
530-749-7999
Woodland Community College
2300 East Gibson Road
Woodland, CA 95776
530-661-5725
Lake County Campus
15880 Dam Road Extension
Clearlake, CA 95422
707-995-7923
2020-2021 Special Circumstance Request
If you or your family has extenuating circumstances that you believe should be considered you may
complete and submit a Request for Special Circumstance. Common special circumstances include, but
are not limited to: unemployment, decreased annual income, and parental divorce or separation. The
regulations do not allow us to consider high mortgage payments, car payments, or consumer debt.
Special Circumstances are considered on a case-by-case basis. Federal regulations limit which
situations we can consider. Submitting this application does not guarantee a change in your financial
aid eligibility.
Important Information and Instructions:
• In order for your special circumstance to be considered you must be enrolled in classes.
• You must meet all federal compliances when the special circumstance application is processed.
• DO NOT leave any questions unanswered. Incomplete requests will NOT be reviewed.
• Dependent students must have a parent signature.
• Provide ALL required documentation under the section that matches your special circumstance.
• Failure to provide all the required documentation may delay the review process and/or result in
the denial of your request.
• Submit all required forms and documents to the Financial Aid Office at the campus you attend.
• Processing of this application takes 4-6 weeks from the time all required documentation has
been received. All Special Circumstance Applications are reviewed by the Director of Financial
Aid.
Applications will be accepted on or after:
September 7, 2020
Deadline to submit application:
April 1, 2021 or next business day
Yuba Community College District
Financial Aid Offices
Yuba College
2088 North Beale Road
Marysville, CA 95901
530-749-7999
Woodland Community College
2300 East Gibson Road
Woodland, CA 95776
530-661-5725
Lake County Campus
15880 Dam Road Extension
Clearlake, CA 95422
707-995-7923
2020-2021 Special Circumstance Application
STUDENT INFORMATION
___
____________________________________________________ _______________________________
First MI Last Social Security #
_______________________________________________________ _______________________________
Mailing Address Home Phone
____
___________________________________________________ _______________________________
City State Zip Code Date of Birth
REASON FOR REQUEST AND DOCUMENTATION REQUIRED
1. Check the appropriate box that pertains to the circumstance(s) which best describes your situation. In
addition, complete the attached application.
S
pecial Circumstance Documents Needed
LOSS OF EMPLOYMENT
Student/Spouse/Parent was working during 2018, but is
now working fewer hours or is unemployed.
• Last or most recent check stub(s) from
l
ast/current employer
• Letter of separation from last employer
• 2018 IRS Tax Return Transcript
• 2018 W-2 Form(s), 1099(s) or other earning
s
tatements
• Current unemployment insurance award
letter or explanation of benefits letter
LOSS OF BENEFITS
Student/Spouse/Parent has lost some or all benefits
(i.e. Unemployment Insurance, State Disability Insurance,
Worker’s Compensation, Child Support).
• L
ast check stub(s) or printout of benefit(s)
received during 2018 and 2019
• Letter from agency verifying termination o
f
b
enefit(s)
• 2018 IRS Tax Return Transcript
• 2018 W-2 Form(s), 1099(s) or other earning
statements
DEDUCTION OF ONE-TIME PAYMENT
Student/Spouse/Parent received a ONE-TIME PAYMENT
(i.e. Pensions, IRA, Annuity, Settlement, Inheritance).
• R
eceipt(s) and/or statement showing amount
of the one-time payment and where/how th
e
on
e-time payment was spent
• Copy of bank account statement(s)
• 2018 IRS Tax Return Transcript
• 2018 W-2 Form(s), 1099(s) or other earnin
g
s
tatements
DEATH OF SPOUSE OR PARENT
Spouse or parent passed away after the FAFSA was filed.
• C
opy of death certificate
• 2018 IRS Tax Return Transcript
• 2018 W-2 Form(s), 1099(s) or other earnin
g
s
tatements
Page 1 Special Circumstance
OTHER
If none of the above circumstance applies to your
situation, please attach a signed statement explainin
g
your circumstance in detail.
• Appropriate documentation to support your
special circumstance
• 2018 IRS Tax Return Transcript
• 2018 W-2 Form(s), 1099(s) or other earnin
g
s
tatements
2.
List the date the change in circumstance occurred: _______________________________
3. Please explain your special circumstance in detail. Attach additional sheets if necessary.
___
______________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
HOUSEHOLD INFORMATION
In the table, list the people living in your household as of July 1, 2020 through June 30, 2021 who will receive
more than half of their support from you, your spouse (if married) or your parents (if a dependent student).
Full Name
Relationship
Age
Self
I c
ertify that the information provided on this form is true and correct to the best of my knowledge. I understand that this
information will be used to determine my eligibility and that false or misleading information may be cause for denial,
termination, and/or repayment of financial aid funds.
____
_______________________________________ ___________________________________________
Student Signature Date Parent Signature Date
Page 2 Special Circumstance
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Special Circumstance Income Projection
Instructions: Please provide expected income to be earned from January 1, 2020 through December 31, 2020.
Include ALL income earned/received from January 1, 2020 until now. Estimate the income you will receive from
now until December 31, 2020. Enter the yearly totals in the table below.
•
Independent student: Provide income for Student and Spouse (if married)
• Dependent student: Provide income for Student and Parent(s)
Student Spouse Father/Stepfather Mother/Stepmother
Earnings From Work $ $ $ $
Unemployment Insurance $ $ $ $
Disability Insurance $ $ $ $
Workers’ Compensation $ $ $ $
Child Support Received $ $ $ $
Social Security Benefits
List type:
$ $ $ $
Pension/Retirement
Benefits
$ $ $ $
Veterans Benefits (non-
educational)
$ $ $ $
TANF/CalWorks $ $ $ $
Interest Income $ $ $ $
Other: $ $ $ $
Page 3 Special Circumstance
FOR OFFICE USE ONLY: Special Circumstance Documentation Submitted /Corrections
2018
Independent Verification
Dependent Verification
2018 1040 Transcript – Student/Spouse
2018 W-2’s / 1099 – Student
2018 W-2’s/ / 1099 – Spouse
2018 1040 Transcript – Parent(s)
2018 W-2’s / 1099 – Father
2018 W-2’s / 1099 – Mother
Child Support
Unemployment or Disability
Workers Compensation Benefits
2019
2019 Check stubs – Student
2019 Check stubs – Spouse
2019 Check stubs – Father
2019 Check stubs – Mother
Child Support
Unemployment or Disability Ins.
Benefits
Workers Compensation Benefits
2020
Independent Verification
Dependent Verification
2020 1040 Transcript –
Student/Spouse
2020 W-2’s / 1099 – Student/Spouse
2020 1040 Transcript – Parent(s)
2020 W-2’s / 1099 – Father
2020 W-2’s / 1099 – Mother
Child Support
Unemployment or Disability
Workers Compensation Benefits
2020 Check Stubs-
Student/Spouse/Mother/Father
2020 1040 Transcript
Page 4 Special Circumstance
Rev. 3/27/20
Estimated Income Student/Spouse Parent(s)
Adjusted Gross Income $ $
Taxes Paid $ $
Exemptions $ $
Student Wages $ $
Spouse Wages $ $
Father/Stepfather Wages $ $
Mother/Stepmother Wages $ $
Additional Financial Info. $ $
Untaxed Income $ $
Number in Household $ $
Number in College $ $
Other Changes: $ $
FA Technician Recommendation: Approve Request Deny Request
Initial EFC/ISIR #: ____________________ /______________ Special Circumstance EFC: ____________________
_____________________________________________________ _________________________________
Financial Aid Technician Date
FA Administrator Decision:
Request Approved
Request Denied
Pending
__________________________________________________ _________________________________
Financial Aid Dean or Director Date
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2020-2021 Special Circumstance Request Financial Aid Offices (Woodland Community College)

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Completed 2 February 2021

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