Re-evaluation of Financial Aid Form
Student Name: ____________________________________________
Last First M
RMC ID#: __________________
Office of Financial Aid
P. O. Box 5005, 114 College Avenue
Ashland, VA 23005
FAX: (804) 752-3719
Randolph-Macon College is committed to providing need-based assistance to qualifying students. The Financial
Aid office recognizes that some families experience changes that are not reflected on the Free Application for
Federal Student Aid (FAFSA). Please note that no request for a re-evaluation will be considered without
a FAFSA and that submission of this form does not guarantee any adjustment to a student’s aid package.
Complete Sections 1-4 and be sure to submit the requested documentation.
SECTION 1: Please check the appropriate box(es) concerning your reason(s) for requesting a re-evaluation of
Loss of Employment
Your parent(s) or your earned income
in 2020 or 2021 will be significantly
less than in 2019 as reported on the
Copy of last pay stub showing
year-to-date earnings.
Termination/layoff notice from
employer, severance package,
and a benefit notice from the
employment office.
Loss of Taxable/Untaxed
Income such as alimony,
business and farm income,
capital gains, child support,
pensions, annuities, social
security, worker’s compensation
and/or other.
Your parent(s) or you received
benefits in 2019 which have ceased
or been reduced in 2020 or in 2021.
Documentation from agency
stating total amount received in
2019 with termination date.
Documentation of updated 2020
or 2021 income amount.
Separation or Divorce
Your parents or you have separated
or divorced AFTER submitting the
A copy of the divorce decree or
separation agreement or proof of
separate residences.
Death of Parent or Spouse
A parent or spouse has died AFTER
submitting the FAFSA.
Copy of death certificate or
Other Financial
Difficulty/Unusual Expense
such as funeral expenses,
unreimbursed medical expenses,
Complete Section 2 and 4.
Submit supporting
documentation, if possible.
SECTION 2: Explanation of circumstances in detail: (Attach additional paper/statement, as needed)
SECTION 3: Report income and benefits from January 1 December 31 for all individuals on the FAFSA. To verify
2019 income, please send all student and parent 2019 W-2 statements and tax schedules.
Taxable Income
Actual Income
Actual Income
Father/Step-father Wages, Salaries, (Gross Amount)
Mother/Step-mother Wages, Salaries, (Gross Amount)
Interest and Dividend Income
Net Income/Loss from Bus. &/or Farm (Sched. C, E, &/or F)
Severance Pay
Vacation or Sick Pay
Stock Options
Capital Gain/Loss
Rental Income/Loss
Taxable Social Security Benefits
Alimony Received
Unemployment Compensation
Pensions/Annuity/IRA Withdrawals
Income from Royalties, Partnerships, Estates and
Untaxed Income
Total Child Support that You Received for all children
Contributions to Retirement Plans
Housing Allowance
Other Untaxed Income
Total Child Support that You Paid to another household
Alimony Paid to another
The information provided on this form is true and complete to the best of my knowledge. I agree to provide additional
documentation if requested. I further agree to notify your office of any error or omission. I understand that failure to
comply with this agreement could result in forfeiture of financial aid. A parent must sign if updating parent
information. Student must sign if updating student information.
_______________________________ ____________ _______________________________ ____________
Student Signature Date Parent Signature Date
(not electronic or digital) (not electronic or digital)
Daytime Phone Number
How much additional aid are you requesting? $_____________________