Student Name (please print)
Financial Aid Appeal
Application – Prospective Student
2020-2021
2020-2021
Before you complete this form, please review the following guidelines:
• You can only apply for a financial aid appeal once per academic year.
• Incomplete appeals or appeals submitted without supporting documentation will be denied.
• Requests for the 2019 Federal Tax Return includes all schedules, statements and business tax returns.
We are unable to consider appeals based on the following:
• Comparison of other financial aid packages
• Consumer debt
• Expenses that have not yet occurred
• Results from the Net Price Calculator
• Voluntary change in employment
• High cost of living
Early Decision I Students
Early Decision II Students
Regular Decision Students
*In order to receive a response to your appeal before the commit
deadline, this form and supporting documentation must be
submitted at least one week before the deadlines listed above. If
your circumstances change after the deadline has passed, please
contact our office.
2. Reason for Appeal (check all that apply and attach required documentation)
Loss or reduction of employment and/or income*
• Date of Employment Change:
• Proof of change (i.e. termination notice, severance statement,
unemployment benefits, etc.)
• Parent(s)’ 2019 Federal Tax Return
• 2019 W-2(s) for all parents in the household
• Minimum of 1 month of 2020 paystubs for all parents in the
household*
• Section 4 of this form
One-Time Source of Income* (amounts exceeding $10,000)
(Ex: capital gains, one-time bonus, gambling winnings, etc.)
• Parent(s)’ 2019 Federal Tax Return
• Section 4 of this form
Recent Divorce/Separation of Parents
• Date of Separation/Divorce:
• Pitzer’s Separation of Tax Return form
• Proof of physical separation (e.g. utility bills with different
addresses).
• Documentation of medical and/or funeral expenses
• Parent(s)’ 2019 Federal Tax Return
• Parent(s)’ 2019 W-2(s)
• Section 4 of this form
Parent Educational Loan Repayments
• 2018 year-end statement from servicer or lender
• Documentation must have parent’s name and monthly
payment amount or summary of 2018 payments
High Medical/Dental/Vision Expenses
Expenses covered under any health insurance program or other
entity (including medical spending accounts) cannot be
considered. Expenses must exceed 5% of total income.
• If you itemized your medical/dental/vision expenses on
Schedule A of your 2018 Federal Tax Return, submit
Schedule A with federal statements showing a breakdown of
the expenses reported on Line 1 of Schedule A.
• If you itemized on Schedule A but do not have federal
statements, provide a breakdown of the expenses reported on
Line 1 of Schedule A.
• If you did not itemize, please provide documentation of
medical bills paid during 2018. Documentation must show the
amount paid, date of payment and description of services for
the medical expense. Most medical companies will be able to
provide account summaries with this information.
Private Elementary/Secondary Tuition Payments
• Documentation from school showing 2019-2020 tuition
payments and estimates for 2020-2021 tuition payments
Elder Care Expenses or Family Support
• Description of expenses and frequency of support for 2018
• Two months of bills/statements/receipts for expenses paid on
person’s behalf for 2018
Documentation will vary based on the type and extent of
damages. Examples of acceptable documentation:
• Copy of parent(s)’ 2019 Federal Tax Return
• Insurance policies, which may include home, car and/or
business to document deductibles or unreimbursed expenses
• FEMA Application
• Contractor quotes, invoices and/or receipts
*Please Note: If you are required to submit copies of your parent(s)’ 2019 Federal Tax Return, 2019 W-2(s) and/or 2020 paystubs and
these documents are not available at the time of your request, please provide any available documents to support your appeal. Copies
of all required documents will be requested at a later date and could change the outcome of your appeal.
