Fillable COVID19 Emergency Funds Form (Community College of Allegheny County)

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COVID19 Emergency Funds Form (Community College of Allegheny County)

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The COVID19 Emergency Funds Form (Community College of Allegheny County) form is 2 pages long and contains:

  • 3 signatures
  • 2 check-boxes
  • 14 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Community College of Allegheny County

BROWSE COMMUNITY COLLEGE OF ALLEGHENY COUNTY FORMS

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Notifications of nondiscrimination and contact information can be found at www.ccac.edu, search keywords “notifications of nondiscrimination.”
Page 1 of 2
The formula used to determine your eligibility for federal financial aid is based in part on your income.
If your family has experienced a significant change in income or if your circumstances have changed
in 2020, in light of the COVID-19 Pandemic, you may request a further review of your financial aid file.
It is important to note that requests for further consideration must be fully documented. Priority will be
given to students who have experienced drastic changes in their circumstances as a result of the
COVID-19 Pandemic. All requests will be reviewed by the Financial Aid Special Conditions
Committee and students will be notified as soon as a decision is made.
Before a review of your file is considered, you must complete this form along with the verification
form. Please attach proof of any supporting documentation for your claim. Indicate the reason(s) for
your request, your anticipated 2020 income and any documented proof of your anticipated income.
Be as specific as possible in your proof and attach any documents that will support your
change in circumstances.
Your financial aid award may not cover all of your tuition costs. It is your responsibility to pay
any outstanding balance by the tuition payment deadline.
IMPORTANT: Typical reasons have been listed below. Please check the reason(s) for your request.
Failure to submit the appropriate documentation will delay or prohibit our ability to accurately review
your situation. The Financial Aid Office may be required to ask for additional documentation not listed
below:
For all circumstances, please submit the following:
• Submit 2019-2020 and 2020-2021 FAFSA Applications, if you have not already done so
• Verification Worksheet
• 2019 Federal Tax Return Transcripts
• 2019 W2 Forms
• Documentation specific to the circumstance(s), as listed below:
Student’s Name: ________________________________________________SS# or ID#: ____________________________
Current Address: ________________________________________________Birth Date: _____________________________
Phone Number: ___________________________ ______________________Email: _________________________________
COVID–19 Emergency Funds Form
Notifications of nondiscrimination and contact information can be found at www.ccac.edu, search keywords “notifications of nondiscrimination.”
Loss Of Employment or Change in Employment Status
Effective Date:________________
• Copy of last paystub from previous employer
• Most recent paystub from new employer, if applicable
• D
ocumentation of unemployment benefits, if applicable
• Termination letter from previous employer, if applicable
Death of a Parent or Spouse
Effective Date:________________
• Copy of Death Certificate
Excessive Medical Expenses
(In excess of 5% of annual income)
Amount Paid in 2018:
$ __________________________
•
Documentation of medical expenses not covered by insurance (Billing
Statements, Receipts, Schedule A of Tax Return)
Other Extenuating Circumstance
Effective Date:________________
•
Applicable documentation (contact Financial Aid Office for further guidance)
In the space provided below, please explain the details of your extenuating financial situation. Please be as specific and
thorough as possible. You should attach an additional sheet if necessary.
By signing this document, I (we) certify that all of the information reported is complete and correct to the best of my
(our) knowledge.
S
TUDENT SIGNATURE: DATE:
Return this form to the Financial Aid office at the campus you are attending
Office Use Only
□Approved Signature: ______________________________
□Denied Date: __________________________________
P
age 2 of 2
PARENT/SPOUSE SIGNATURE:
DATE:
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COVID19 Emergency Funds Form (Community College of Allegheny County)

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Completed 26 July 2020

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