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.
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
• 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:____________________
