Fillable 2020-2021 Special Circumstances Request (Wayne Community College)

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2020-2021 Special Circumstances Request (Wayne Community College)

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  • 15 check-boxes
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Continued
2020-2021
Special Circumstances Request
S
TUDENT NAME: _________________________________________________
WCC ID: ______________________________
In accordance with FAFSA requirements, a family’s 2018 income is used to determine financial need for the 2020-2021 school year.
You may use the Special Circumstances Request form to inform us of changes in your and/or your family’s situation since filing the
2018 Federal Income Tax Return. Completion of the Special Circumstance Request form does not guarantee approval for the Federal
Pell Grant or other types of need-based aid.
1) PERSONAL STATEMENT
Explain how your family income has changed since the 2018 federal tax returns were filed and the estimated family
income for 2020 that you wish to be considered for Special Circumstances review. You must submit proof of these
circumstances with this form. Use additional paper if necessary.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
2) SPECIAL CIRCUMSTANCE(S)
Select the circumstance(s) for which you are requesting an individual review of your 2020-2021 FAFSA:
Loss of employment or income due to layoff, company closure, termination, or involuntary resignation since the last
tax year reported on the most recent FAFSA Yes No
Full Name: __________________________________ Relationship to student: _________________________
Last date of employment: _____________________ Date of lost wages from: ____________ to ____________
Type of earnings or benefits lost: _________________ Amount of earnings or benefits lost: ________________
— Provide evidence of loss of employment (signed letter or notice on company letterhead).
— Provide evidence of loss of benefits (court decisions, letters of denial)
— Proof of unemployment insurance, pay stubs or letter stating that unemployment was denied, and other sources of
income earned in 2020.
Separation or divorce since filing the FAFSA. Student Parent
Date of separation/divorce: ______________ Number of family members remaining in household: __________
Number of family members in college: _____ Total child support received or expected to receive: ___________
— Provide legal documentation of separation/divorce [court documents, divorce decree, or proof that the student and
spouse or the parents are residing separately (copy of lease agreement, utility bills, etc.).]
Death – A parent or spouse received income for 2018 and has passed away. Yes No
Date of death: _______________ Full Name of deceased: _________________________________________
Relationship to student: ________________________ Number of family members in household: ___________
Number of family members in college: __________
— Provide legal documentation of death (a copy of death certificate).
On
e-time non-recurring income: Student/Spouse Parent (dependent student only)
(Inheritance, retirement, IRA distribution, etc. that was reported on the 2018 IRS Tax Return but is not expected to
reoccur in the future).
— Attach evidence of one-time income (legal forms, financial statements, etc.)
— Signed statement identifying the source of income and how the funds were spent or invested.
Excessive out-of-pocket medical/dental expenses not covered by insurance. Student/Spouse Parent (dependent
student only) NOTE: a review will not be considered for individual medical/dental bills or statements.
— Submit proof of medical/dental expenses paid in 2018 and NOT covered by insurance if you did not itemize deductions
on your federal tax return. Your personal statement from step 1 must include the total amount you paid out-of-
pocket.
★
RETURN THIS COMPLETED FORM WITH ALL SUPPORTING DOCUMENTATION TO:
Wayne Community College – Financial Aid Office – PO Box 8002 – Goldsboro, NC 27533
FAX: 919-736-9425
Wayne Community College is accredited by the Southern Association of Colleges and Schools Commission on Colleges to award associate degrees. Contact the Commission on Colleges at 1866
Southern Lane, Deactur, Georgia 30033-4097 or call 404-679-4500 for questions about the accreditation of Wayne Community College. The Commision on Colleges may be contacted only if there is
evidence that Wayne Community College is significantly non-compliant with a requirement or standard. Accreditation standards are located at http://www.sacscoc.org/principles.asp. Inquiries about
Wayne Community College, such as admissions requirements, financial aid, educational programs, etc. should be addressed directly to Wayne Community College and not the Commission’s Office.
Other circumstance(s) not listed on this form:
Student/Spouse
Parent
(dependent student only).
— Explain this circumstance:
________________________________________________________________________________________________
________________________________________________________________________________________________
— Provide proof of the circumstance(s) you wish to have considered
NOTE: a review will not be considered for a parent’s unwillingness to help pay for college, consumer debt, or
mortgage/rent expenses.
3) COMPLETE AND ATTACH THE FOLLOWING FOR SPECIAL CIRCUMSTANCE(S) CONSIDERATION
—
Completed WCC Verification Worksheet (Independent or Dependent)
— Signed copies of the 2018 and 2019 IRS Tax Return Transcripts (available at www.irs.gov) for student/spouse and/or parents of
a dependent student. If a tax return was not filed, attach a signed copy of the IRS Verification of Non-Filing letter dated on or
after 10/01/19.
— Copies of all 2018 & 2019 W2’s, 1099’s, and/or other statements of income earned from working for the student/spouse and/or
parent(s) of a dependent student.
— Special Circumstances Estimated Income Worksheet.
SPECIAL CIRCUMSTANCES ESTIMATED INCOME WORKSHEET
Please provide the amounts that you and your family expect to receive between 01/01/2020 and 12/31/2020. You must attach
supporting documentation of your 2020 income.
Anticipated Income for 2020
Actual Income
01/01/20 - today
+
Estimated Income
Today – 12/31/20
=
2020 Total Income
(wages, salaries, tips, net business/farm income)
$
+
$
=
$
Student’s expected 2020 unemployment compensation $
+
$
=
$
Spouse’s expected 2020 income earned from work
(wages, salaries, tips, net business/farm income)
$
+
$
=
$
Spouse’s expected 2020 unemployment compensation $
+
$
=
$
(wages, salaries, tips, net business/farm income)
$
+
$
=
$
Disability Income $
+
$
=
$
Child Support $
+
$ = $
Workers Compensation $
+
$ = $
Other: __________________________ $
+
$ = $
Total Income for 2020
$ $ $
4) CERTIFICATION AND SIGNATURE
By signing below, I certify that the information provided on this form, attached worksheets, and other supporting documentation is true and
c
omplete as of this date. I understand that the request for an individual review is not guaranteed to result in a change to my financial ai
d
pac
kage. I further understand that the Special Circumstances Request does not guarantee approval for the Federal Pell Grant or other
types of need-based aid. Completion of this form is not a substitute for payment of applicable charges to the College.
Purposefully giving false or misleading information may result in fines up to $20,000, imprisonment or both. The Secretary of
Education has the authority to verify information reported on the FAFSA with the IRS and other federal agencies.
STUDENT SIGNATURE: ______________________________________
DATE: _______/_______/20_______
PARENT SIGNATURE: _______________________________________
(Dependent student ONLY)
DATE: _______/_______/20_______
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2020-2021 Special Circumstances Request (Wayne Community College)

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Completed 26 July 2020

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