Everett
Community College does not discriminate based on, but not limited to, race, color, national origin, citizenship, ethnicity, language,
culture, age, sex, gender identity or expression, sexual orientation, pregnancy or parental status, marital status, actual or perceived disability,
use of service animal, economic status, military or veteran status, spirituality or religion, or genetic information.
ADDITIONAL REQUIRED DOCUMENTATION (for your specific circumstance)
Please select the circumstance below that best applies to you and/or your family. You are required to
supply all of the documentation listed in the section you choose.
Dependent students are required to provide information for their parent(s).
Independent students are required to provide information for themselves (and their spouse, if applicable).
Reduction or loss of income
The 2019 income on your FAFSA/ WASFA does not reflect your current income due to the loss of a job, a
reduction in hours, or the income including a one-time benefit. You (and your spouse or parent(s)) must
provide:
1) Relationship to student: ________________________
Date change occurred: ________________________
Date of new job, if applicable: ____________________
2) If change occurred in 2020: Student/spouse or parent(s) 2020 tax forms and W-2
OR
If change occurred in 2021: Most recent paystub(s) with Year-to-Date (YTD) listed for all jobs
3) If applicable, Year-to-Date (YTD) statement of unemployment benefits or other benefits
Divorce, separation, or change in marital status after application submitted
At the time you completed the FAFSA/ WASFA, you either 1) included your spouse’s income but since
then have divorced or separated, or 2) included both parent’s income but they have since divorced or
separated. You or your parent (if applicable) must provide:
1) Relations
hip to student: _________________________
Date marital status change occurred: _______________
If ap
plicable, Child support received/ paid per month. Date began: __________ Amount: $ _________
Alimony received/ paid per month. Date began: __________ Amount: $ _________
Mark one: Recei
ved ____ Paid: _____
2) Most recent paystub(s) with Year-to-Date (YTD) listed for all jobs for student and spouse or parent
Death of a spouse or parent
At the time you completed the FAFSA/ WASFA, you included income from a spouse or parent that has
since passed away. You or your parent (if applicable) must provide:
1) A death c
ertificate or obituary
2) You or your living parent’s most recent paystub(s) from all jobs, with 2021 Year-to-Date (YTD)
earnings listed
CERTIFICATION
By signing this worksheet, I affirm that I have read, understood, and agreed to this form in its entirety and that the
information supplied is true and complete.
Student Signature _______________________________________
Parent Signature (if applicable) ______________________________
Date _______________________
Date ______________________
