Office of Financial Aid
323 Erie Street, P.O. Box 5015, Port Huron, Michigan 48061-5015
810-989-5530 fax 810-989-5774 sc4.edu
4/9/2020
2020-21 Special Circumstances Appeal Form
Name _______________________________________ Student No. (SSN) _________________________
Eligibility for 2020-2021 financial aid is determined by many factors, including 2018 income. However, certain life events sometimes
deem it more appropriate to use your current and projected income to determine your eligibility for federal aid. This form may be used
to report involuntary, permanent income changes, unusual expenses, or changes in financial circumstances expected for the 2020
calendar year. The information provided on this form as well as other requested documentation will be used to consider changes in your
family’s financial status. The Office of Financial Aid will use that information to evaluate your 2020 projected income to determine if
allowable adjustments could or should be made that present a more realistic picture of your family’s ability to contribute toward the cost
of a college education. Typically, a 20% or more reduction in total family income may cause a change in eligibility.
You (and your parents, if dependent) must provide all required/requested documentation. For appeals submitted during or after
November/December 2020, the 2020 IRS Federal Tax Return(s) and W-2 Forms are also required.
Please check the box next to the situation that applies to your family.
Special Circumstance
Required Documents
Divorce or Separation
(Student or Parent)
Copy of divorce decree/separation papers or evidence of separate living accommodations.
2018 signed Tax Return(s) and 2018 W-2 Forms
2019 signed Tax Return(s) and 2019 W-2 Forms
Provide a detailed letter of appeal that explains how your family’s financial situation has changed since
2018
2020-2021 Verification Worksheet
Retirement
(Student, Spouse or
Parent)
Letter of separation from employer (on company letterhead)
Copy of last pay stub showing earnings.
Statement of retirement benefits.
Provide a detailed letter of appeal that explains how your family’s financial situation has changed since 2018
2020-21 Verification Worksheet
2018 signed Tax Return(s) and 2018 W-2 Forms
2019 signed Tax Return(s) and 2019 W-2 Forms
Death of
Parent/Spouse
Photocopy of death certificate.
Provide a detailed letter of appeal that explains how your family’s financial situation has changed since
2018
2020-21 Verification Worksheet
2018 signed Tax Return(s) and 2018 W-2 Forms
2019 signed Tax Return(s) and 2019 W-2 Forms
Involuntary Loss of
Employment
(Student, Spouse or
Parent)
Letter of separation from employer (on company letterhead)
Copy of last pay stub from previous employer
Letter from current employer(s) stating wages earned to date and estimated 2020 calendar year income
Copy of Unemployment Benefit Payment History OR statement of ineligibility.
Provide a detailed letter of appeal that explains how your family’s financial situation has changed since
2018
2020-21 Verification Worksheet
2018 IRS signed Federal Tax Return(s) and 2018 W-2 Forms
2019 IRS signed Federal Tax Return(s) and 2019 W-2 Forms
Loss of Other Income
(Student, Spouse or
Parent)
Statement of Benefits (e.g. social security).
Letter regarding ending payments from parent paying child support or statement from Friend of the Court,
including stop date and amounts.
Provide a detailed letter of appeal that explains how your family’s financial situation has changed since
2018
2020-21 Verification Worksheet
2018 signed Tax Return(s) and 2018 W-2 Forms
2019 signed Tax Return(s) and 2019 W-2 Forms
Medical Expenses
(not included on
Federal 1040
Schedule A)
Medical receipts.
Provide a detailed letter of appeal that explains how your family’s financial situation has changed since
2018
2020-21 Verification Worksheet
2018 signed Tax Return(s)
2019 signed Tax Returns(s)
Student ID:_______________
Rec’d by:_________________
Date:____________________
Office of Financial Aid
323 Erie Street, P.O. Box 5015, Port Huron, Michigan 48061-5015
810-989-5530 fax 810-989-5774 sc4.edu
4/9/2020
Be certain you have completed the following before submitting your appeal to us:
Please complete all sections (both sides) of this form. If the answer is zero or not applicable, write a “0” in the appropriate place.
If income is “Other Taxable Income” (column 4) or “Other Untaxed Income” (column 5) please circle the source of income being
reported
Attach all documentation as required and sign/date the bottom of this sheet.
2020 Income
(earned and/or
projected)
Parents’ Income
From Work
(Gross)
Student and/or
Spouse’s
Income
From Work
(Gross)
Interest/Dividend
Income,
Alimony,
Pension
Benefits,
Annuities and
Other Taxable
Income
January 2020
$
$
$
February 2020
$
$
$
March 2020
$
$
$
April 2020
$
$
$
May 2020
$
$
$
June 2020
$
$
$
July 2020
$
$
$
August 2020
$
$
$
September 2020
$
$
$
October 2020
$
$
$
November 2020
$
$
$
December 2020
$
$
$
TOTAL
$
$
$
Office of Financial Aid
323 Erie Street, P.O. Box 5015, Port Huron, Michigan 48061-5015
810-989-5530 fax 810-989-5774 sc4.edu
4/9/2020
Certification: All of the information on this form is true and complete to the best of my knowledge. I understand I may be asked for
additional documentation. I realize that if I do not give proof when requested, I, the student, may be denied aid.
Student’s Signature _________________________________________________ Date _________________
Parent’s Signature __________________________________________________ Date _________________
(dependent students only)
If you are able, please print and physically sign this form. If you do not have access to print, please type your name above, but you
and your parent (only if dependent student) will need to come into the Financial Aid office once we re-open to sign.
Submit this worksheet to the Financial Aid Office at SC4.
St. Clair County Community College
financialaid@sc4.edu
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