Fillable 2021 Special Conditions (Northwest State Community College)

Fill Online, Printable, Fillable, Blank 2021 Special Conditions (Northwest State Community College) Form

Use Fill to complete blank online NORTHWEST STATE COMMUNITY COLLEGE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

2021 Special Conditions (Northwest State Community College)

On average this form takes 10 minutes to complete

The 2021 Special Conditions (Northwest State Community College) form is 2 pages long and contains:

  • 0 signatures
  • 13 check-boxes
  • 34 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Northwest State Community College

BROWSE NORTHWEST STATE COMMUNITY COLLEGE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Northwest State Community College • 22600 State Route 34 • Archbold • OH • 43502
Phone: 419-267-1333 • Fax 419-267-5587 • finaid@northweststate.edu
1
Student Name: ___________________________________ NSCC ID number: N________________________
Email Address: ___________________________________________ Date of Birth: _____/_____/_____
Financial need is, in part, based on each student’s or families’ gross annual income from the 2018 tax year. If your income has recently
decreased or you have an unforeseen financial hardship that was not taken into account on your Free Application for Federal Student Aid
(FAFSA), we may be able to re-evaluate your financial need based on your projected gross income for the 2020 tax-year (January 1, 2020 –
December 31, 2020). Please remember that not all special circumstance recalculations will result in additional financial aid and allow
up to 6 weeks for the financial aid office to review your request.
INSTRUCTIONS: For the rest of this form, if you are dependent, you must provide information for yourself and your parent(s). If you are
an independent student, you must provide information for yourself and your spouse (if married). Complete all sections and attach required
documentation. Please complete Steps 1-3.
STEP #1
Are you (or your spouse/parents) receiving any of the following? Check all that apply:
_____SSI _____Food Stamps _____Free/Reduced Lunch _____TANF _____WIC _____Medicaid
Are you (or your spouse/parents) a dislocated worker? _____Yes _____No
If you (or your spouse/parent) have quit your job you are not considered a dislocated worker
STEP# 2
Complete the chart below estimating all income for the 2020 calendar year. (January 2020 - December 2020).
Student (include spouses income)
Parent (include both parents)
Adjusted Gross Income
Income from work
$______________________
$______________________
Unemployment
$______________________
$______________________
Taxable Social Security
$______________________
$______________________
Other taxable income (explain)___________
$______________________
$______________________
Untaxed Income
Payments to tax deferred pensions
$______________________
$______________________
IRA deductions
$______________________
$______________________
Child Support
$______________________
$______________________
Untaxed portions of IRAs or pensions
$______________________
$______________________
Workman’s Compensation
$______________________
$______________________
Disability
$______________________
$______________________
Other Untaxed Income (explain)___________
$______________________
$______________________
Total Cash Savings and Checking
$______________________
$______________________
All of the information provided by me, or any other person, is true and complete to the best of my knowledge. If asked by an authorized official,
I agree to give proof of the information that I have given on this form. I realize that underestimating projected income could result in reduced
eligibility, repayment of aid, or both. I further understand that purposely giving false or misleading information may subject me to fines and/or
other penalties.
_____________________________________________ __________________________
Student’s Signature Date
_____________________________________________ __________________________
Parent’s Signature (if parent special condition) Date
2020-2021 Special Condition
Northwest State Community College • 22600 State Route 34 • Archbold • OH • 43502
Phone: 419-267-1333 • Fax 419-267-5587 • finaid@northweststate.edu
2
STEP #3 - Please provide copies of each the following items:
Signed copy of 2018 Federal Tax Form 1040 and Schedules 1-6 or 2018 Federal Tax Transcript
(request at www.irs.gov)
2018 W-2 statement(s) for student/spouse (independent student) or mother/father (dependent
student)
2020-2021 Dependent/Independent Verification Group V1 worksheet
STEP #4 - Please check the circumstance which applies and provide the addition al information that is requested
for each situation. The requested documentation must be attached to this form when returned to the Financial Aid
Office.
_____a) Unemployment, reduced employment or job change.
Student/Spouse/or Parent must be unemployed for at least 10 weeks in 2020.
Typed letter explaining your special circumstance. Please make sure to sign and date your letter.
Last check stub(s) from previous employer
Letter from previous employer stating the date of termination
Benefit or denial letter of unemployment
Check stub of new employment or statement regarding employment status
_____b) Separation or Divorce
Typed letter explaining your special circumstance. Please make sure to sign and date your letter.
Court documentation verifying legal separation or divorce
Statement of any child support received for the dependent children or child support paid to children
not living in your home.
_____c) Death of a Parent or Spouse
Typed letter explaining your special circumstance. Please make sure to sign and date your letter.
Copy of a death certificate, obituary notice, or printed memorial program.
Statement of how the deceased is related to the student (may include in letter)
_____d) Unusual Medical or Dental expenses paid but not covered under insurance
Total expenses
paid
must be more than 11% of your AGI. (The EFC calculation accounts for 11% of your
income to be used to pay medical/dental bills)
Typed letter explaining your special circumstance. Please make sure to sign and date your letter.
Copy of Medical or Dental bills that were paid in 2020 that were not paid by a third party.
Include in letter, Total amount of debt or expense and explanation of hardship
Proof of payment of Medical or Dental bills without insurance coverage
_____e) Other -- You have a situation you would like to have reviewed; ex: Retirement, Reduced or
Terminated Untaxed Income, Liquidation/Foreclosure, Unusual Debt or Expenses.
Typed letter describing any changes in financial circumstances and explain how it has affected the
ability of you and/or your family to contribute to your education. Make sure to sign and date your
letter.
Northwest State Community College does not discriminate on the basis of race, color, national origin, sex, gender identity, disability, religion or
age in its programs or activities.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

2021 Special Conditions (Northwest State Community College)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 3 October 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document