2021-2022 Petition for Special Circumstances
Income Adjustment
Student Name:
________________________________ GCU Student Number: _____________
Phone Number: ________________________________
GCU Office of Financial Aid may use professional judgment (PJ) on a case-by-case basis to
review extenuating circumstances that are now affecting the student’s income. These
extenuating circumstances may include substantial loss of income or assets or recent
unemployment of a family member. If due to recent unemployment, this application cannot be
submitted until unemployment compensation has been confirmed/denied. A PJ for a loss of income is
not required if the EFC is 0.
Please note: If PJ is requested due to change in marital status where you are no longer
considered married, but are still an independent student, please request a Separation of Income and
do not continue with Income Adjustment PJ.
Please complete the section below and submit the required document(s) to your GCU Student Services
Counselor for review.
Income Adjustment
If there has been significant changes to your and/or your parents'/spouse’s income due to extenuating
circumstances listed above, please provide a brief explanation below and submit the following
documents that apply to your request:
__________________________________________________________________________________
__________________________________________________________________________________
d Submit 2019 IRS Tax Return Transcript or signed copy of the IRS tax return that was submitted to
the IRS. (If filed separately, also need spouse’s 2019 IRS Tax Return Transcript/signed IRS tax return.)
Please note, additional information may be requested.
Page 1 of 3 P0201202021
____________
____________
Most recent paystubs from all employers and copies of all W-2s for the tax year in which the
loss/increase occurred.
If appeal is due to loss of employment, need a letter from former employer(s) confirming last date
of employment. If this is not possible, a signed and dated statement confirming las
t date of
employment
will
b
e acceptable.
Submit a copy of the Unemployment Maximum Benefits Statement pertaining to the specific loss or
an Unemployment Denial Letter (if applicable).
Provide evidence of failed business or farm, and/or loss of asset(s) by providing 2019
Schedule C, Schedule F, Schedule K-1, and/or Schedule SE
Parents' 2019 Tax Return Transcript or signed copy of the IRS tax return. (Dependent student only.)
An estimate of projected income through the current calendar year (next page)
Projected Income Worksheet: Please complete this worksheet for all income projections through the
current calendar year.
Last Date of Employment (if applicable) _________________________________
Please list by month the amount(s) of projected income for the current calendar year
for all applicable sources of
income. Documentation must be provided for every family member
whose information is supplied in the worksheet below. Actual amounts must be indicated for months
that have already passed as of the date this petition is submitted to your GCU Student Services
Counselor and estimated amounts
must be indicated for the remaining months.
Please note: For any months in which $0 income is reported, please indicate how you and/or your spouse/
parent(s) will b
e supported by attaching a signed and dated written statement.
Income Earned from Work
Gross Wages
Student
Spouse
Parent 1 Parent 2
Other
January
February
March
April
May
June
July
August
September
October
November
December
Total
$
$
$
$
Page 2 of 3 P0201202021
0.00
0.00
0.00
0.00
0.00
Unemployment
Gross Wages
Student Spouse Parent 1 Parent 2 Other
January
February
March
April
May
June
July
August
September
October
November
December
Total
$ $ $ $ $
If there are any blank boxes in the grid above, an Unemployment Denial letter is required.
For months where Unemployment is listed, please provide Maximum Benefits Statement.
Worker’s Compensation/Disability
Gross Wages
Student Spouse Parent 1 Parent 2 Other
January
February
March
April
May
June
July
August
September
October
November
December
Total
$ $ $ $ $
Page 3 of 3 P0201202021
If disability, please indicate type:
Veteran's Administration Other Disability
Student Signature: __________________________________ Date: _____________________
HANDWRITTEN SIGNATURE REQUIRED TYPED/ELECTRONIC SIGNATURE NOT ACCEPTED
Social Security
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00