Fillable Appeal for Special Circumstance Policy (New York Department of Motor Vehicles)

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Appeal for Special Circumstance Policy (New York Department of Motor Vehicles)

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  • 9 check-boxes
  • 70 other fields

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
University
of
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Amher
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Examples of es c ed:
Examples of es NOT c ed:
na ial A erv es ass.edu/fi nc id
Academic Year 2022-2023
Fax: 413-545-1700
Phone: 413-545-0801
Financial Aid Services
Appeal for Special Circumstance Policy
Appeal Policy:
Your eligibility for financial aid was initially calculated based on the information you provided on the Free Application
for Federal Student Aid (FAFSA). Using this information all families undergo a consistent evaluation of the family’s
ability to pay for college. The formula assumes that 2020 income is a good indicator of the family’s financial strength
during the student’s 2022-2023 enrollment.
Financial Aid Services at the University of Massachusetts Amherst recognizes that families experience changes in
income or other family circumstances that are not reflected in the 2020 tax return information. Therefore it is possible
for students to appeal their financial aid eligibility if they have special financial circumstances.
Examples of Special Circumstances considered:
Special Circumstanc
Special Circumstanc onsider
Examples of Special Circumstances NOT considered:
onsider
Reduction of income or benefits in 2022.
Home repairs
Extraordinary medical or dental expenses in 2021.
Private school tuition
Death of a parent or spouse whose information is on the
Credit card debt
FAFSA form.
Mortgage payments
Divorce or separation after filing the 2022-2023 FAFSA
Weddings and other major purchases
form.
Car payments
Withdrawal of IRA/Pension for 2020.
Previous educational loan debt
Please remember, granting appeals is based on a one-time special circumstance. It also depends on the availability of
funds and the timeliness of your FAFSA. Submitting this form does not guarantee an adjustment or increase in your
financial aid. In the event that we are not able to offer additional financial aid please review the alternative financing
options available to help finance your education. Information regarding loans is available on our website at
umass.edu/financialaid. Please refer to the Bursar’s website for information on payment plans at umass.edu/bursar.
Appeals are reviewed within 30 days after receipt of all required and supporting documentation. However, response time
may vary depending on volume of appeals at the time of your request.
If you determine that your 2022 income will be the same or higher than 2020, do not complete
this form.
Please do not disregard your university bill due date while waiting for the appeal decision.
Fi
Financial Aid Services
nc id S ic um na iala
umass.edu/financialaid
243 Whitmore Administration Building 181 Presidents Drive Amherst MA 01003
Email: finaid@finaid.umass.edu Phone: 413-545-0801 Fax: 413-545-1700

University
of
Massachusetts
Amherst
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Name: (Last , First, MI) _______________________________ UMass SPIRE ID:________________________
Email: _________________________________________ T Number: ( ) _______________
Academic Year 2022-2023
Fax: 413-545-1700
Phone: 413-545-0801
Financial Aid Services
Appeal for Special Circumstance
Name: (Last , First, MI) _______________________________ UMass SPIRE ID:________________________
Email: _________________________________________
elephone
Telephone Number: ( ) _______________
A. Did you file a financial aid appeal during the 2021-2022 Academic Year? Ye N
B. Appeal Categories and Supporting Documentation:
Carefully read and select the categories from the following list that most closely describe your special circumstance(s)
and provide all supporting documents. Incomplete appeals will not be considered after 60 days.
2020 Federal Tax Return documents are REQUIRED for all Appeal for Special Circumstance.
For office use
Type of appeal (check all that apply)
Documentation to include with appeal
only
Decrease in student/spouse income from
employment in 2022 of at least 8 weeks.
Decrease in parent income from
employment in 2022 of at least 8 weeks.
Unreimbursed medical or dental
expenses paid in 2021
Death of immediate family member
whose information is on the FAFSA.
Divorce or separation after filing the
2022-2023 FAFSA form.
Secondary special education paid in 2021.
Withdrawal of IRA/Pension for 2020.
• Statement documenting retirement benefits for 2022.
• Letter from employer documenting employment status (e.g. full-time to part-time or termination).
• Unemployment Benefits statement.
• Last pay stub after separation from job. If after January 1
st
, 2023, please submit copies of 2022 W-2 s.
• Copies of statements indicating severance pay.
• Statement documenting retirement benefits for 2022.
• Letter from employer documenting employment status (e.g. full-time to part-time or termination).
• Unemployment Benefits statement.
• Last pay stub after separation from job. If after January 1
st
, 2023, please submit copies of 2022 W-2 s.
• Copies of statements indicating severance pay.
• Provide a summary of PAID unreimbursed expenses (deductibles, co-pays, after tax insurance,
prescription medications, expenses for durable medical equipment, and other amounts not covered
by insurance) for 2021.
• Cobra payments made in 2021.
Elective cosmetic or dentistry expenses will not be considered.
FAPSRT
FAPLES
FAPSUB
FAPSWG/FAPSW2
FAPSEV
FAPPRT
FAPLES
FAPPUB
FAPPWG/FAPPW2
FAPSEV
FAPMED
FAPCOB
• Provide copies of 2020 W-2 forms.
N/A
• Complete copy of divorce decree or complete copy of separation agreement. If no legal separation
documentation exists, provide a statement indicating the date of the separation.
• Provide documentation for both parents’ living expenses at different addresses (e.g.: rental
agreement, lease or mortgage statement and utility bills).
• Provide agreement of financial support payments (e.g. alimony, spousal support, child support or
dependent care).
• List the number of family members currently in the household.
• Copies of 2020 W-2 forms.
• Documentation of the special education school requirements for siblings.
• Documentation of paid expenses for 2021.
• Letter explaining the reason for the withdrawal and copy of 2020 1099R.
Acceptable appeals include supplementing income due to recent employment loss and educational
expenses paid.
FAPDIV
FVPSAG
FAPCHL
FVCLEA/FVNLEA
N/A
FAPSED
Page 1
*FAPSPO*
University
of
Massachusetts
Amherst I iih
flii
i&BH
________________________________
_______________________
__________________
__________________
Financial Aid Services
Academic Year 2022-2023
Fax: 413-545-1700
Phone: 413-545-0801
Appeal for Special Circumstance
Name:________________________________
UMass SPIRE ID:_______________________
C. Income Information for 2022:
The following section requires you to provide your actual and expected 2022 income.
Do not enter an hourly wage. Instead, please compute the annual amount of earnings you have or expect to earn.
Parent 1: Parent 2:
Documents
Parent 1 name:__________________
Expected 2022 Income Student Spouse Required
Parent 2 name:__________________
Gross Income EARNED from work:
1/1/2022 through present date
$ $ $ $
Current or Final Pay Stub
Gross Income TO BE EARNED
from work: present date through
12/31/2022
$ $ $ $
Current Pay Stub
Severance Pay
$ $ $ $
Letter from Company/Final
Pay Stub
Unemployment Benefits
$ $ $ $
Documentation from Agency
Worker’s Compensation Benefits
$ $ $ $
Documentation from Agency
Social Security Benefits
$ $ $ $
Long/Short Term Disability Benefits
$ $ $ $
Business Income
$ $ $ $
Letter from Accountant or
Quarterly Statement
Other Income including Untaxed
Income
$ $ $ $
Alimony
$ $ $ $
Letter from Court
Child Support Received
$ $ $ $
Letter from Court
Pension Distributions
$ $ $ $
Letter outlining how funds
were used
Early Withdrawal from Retirement
Funds
$ $ $ $
Total Expected 2022 Income:
$ $ $ $
Page 2
*FAPSPO*

University
of
Massachusetts
Amherst
EHifrflmlfBM
Academi ea 2-2
_________________________________
________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
November 1, 2022 -
your for the fall 2022
A 2
your for the 23 er.
__________________________________________ _________________________
___________________________________________ __________________________
41 5-1700
.edu/fi
Academic
c Y
Year
r 202
2022-2023
023
Fax: 413-545-1700
Phone: 413-545-0801
Financial Aid Services
Appeal for Special Circumstance
Name:_________________________________
UMass SPIRE ID:________________________
D. Personal Statement:
Explain below what has caused the changes in your family’s circumstances.
Attach a separate sheet if necessary. Remember to write your name and SPIRE ID on each page.
Please submit completed form with supporting documentation to Financial Aid Services no later than:
November 1, 2022 -
if appeal is
if your appeal is for the fall 2022
pril 2, 20 3 -
appeal is semest
April 2, 2023 -
if spring 20
if your appeal is for the spring 2023 semester.
If any information or documents are missing or incomplete, your appeal cannot be processed.
E. Signature and Certification:
I certify that the information submitted for this appeal is true and complete to the best of my knowledge. I agree to provide all
supporting documentation required. I understand that failure to comply may result in the cancellation of this appeal. I further
understand that if I have provided information in previous appeals, this may be reviewed for accuracy and it may impact the
outcome of this and or any future appeal. It is the family’s responsibility to notify our office if any of the above information
should change. This notification should occur within two weeks of any change.
Please do not disregard your university bill due date while waiting for the appeal decision.
Student Signature: __________________________________________ Date: _________________________
Parent Signature: ___________________________________________ Date:__________________________
(Required for Dependent Student)
Fax completed signed form to:
3-54
413-545-1700 or
Secure Document Upload at:
umass
umass.edu/fi
nancialaid/upload
nancialaid/upload
Page 3
*FAPSPO*
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Appeal for Special Circumstance Policy (New York Department of Motor Vehicles)

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Completed 16 March 2022

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