2020-21 Special Circumstance Request
Office of Financial Aid
LAST NAME
FIRST NAME
MI
STUDENT ID
KCTCS E-MAIL ADDRESS
ADDRESS
PHONE
CITY
STATE
ZIP
This form is used to re-evaluate your eligibility for 2020-21 financial aid. We will act on your request for a re-
evaluation only after receiving supporting documentation which confirms your circumstance(s). Please be
aware that a re-evaluation does not guarantee an increase in your financial assistance. An increase depends on
the availability of funds and demonstrated financial need. Decisions may take 4-6 weeks.
I am officially requesting a recalculation of income for the 20-21 school year.
I have provided the following documentation (if selected for verification):
Completed Verification Worksheet
Copies of 2018 federal tax return transcripts/returns
Copies of 2019 federal tax return transcripts/returns
Copies of my W2s and my spouse’s and parents’ (if applicable)
Option 1: Loss or change of employment
Student
Spouse
Parent 1
Loss of Employment
Change of employment
Reduced employment
What date did the change occur? ___/_________
I am providing the following documentation to support the change in income:
Last check stub showing year-to-date income
Termination statement from employer
Statement of unemployment compensation
Statement of loss of unemployment
Other: ______________________________________
Briefly provide any further explanation to clarify the changes:
Option 2: Death, Divorce, or Separation
Student
Spouse
Parent 1
Parent 2
Death
Divorce
Separation
N/A
What date did the change occur? ___/_________
I am providing the following documentation to support the change:
Copy of death certificate
Copy of divorce decree
Written, notarized documentation of separation
Option 3: Other special circumstances
for
Spouse
Parent 1
Parent 2
Other circumstance
What date did the change occur? ___/_________
Describe the special circumstance:
I am providing the following documentation to support the change:
I agree that all supplied documentation and information is true and accurate to the best of my knowledge. I
understand that requesting a recalculation does not guarantee I will receive grant funds. I understand that
income from my spouse, parents (if applicable), and myself, all factor into the formula. I recognize that KCTCS
is simply acting as an agent to exclude portions of my income that no longer contribute to my household.
Student Signature: ____________________________________________ Date: _____________________
Parent Signature: ______________________________________________ Date: _____________________
Financial Aid Office Use Only
FA Comment: ______________________________________________________________________________________
Signature: ____________________________________ Date: ______________________________
KCTCS is an equal opportunity employer and education institution
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