College of DuPage 2019-2020 Special Conditions Review Request
Office of Student Financial Assistance
2019-2020 Special Conditions Review Request 1 11/16/18
Last Name: First Name: Student ID:
Important information:
• You must be able to document your special condition(s). Required documentation for each category is listed below.
Additional documentation may be required upon review of your circumstances. The review process cannot be
completed until all requested information and documentation has been received.
• If you were not originally selected for verification, you may still need to verify the information you reported for 2017
on your FAFSA by submitting 2017 IRS Tax Transcripts and/or additional documentation.
• Not everyone who submits a review request will receive additional aid. If the EFC from your FAFSA is “0”, you already
have the maximum eligibility. Changes to 2018 or 2017 income that are not a significant reduction from the income
reported on your FAFSA (calendar year 2017) may not produce a change in eligibility.
• If you have questions, please contact the Office of Student Financial Assistance at (630) 942-2251 or
specialreview@cod.edu
for assistance.
Please complete the applicable section(s) below, and on the back of this form:
□ Loss of work income due to total,
partial or temporary loss of
employment, or reduction in work
hours. Note: Loss cannot be
voluntary.
□ Student
□ Spouse
□ Father
□ Mother
• Notice from employer stating the date of termination, lay-off, work
reduction, etc. (as applicable).
• Copy of 2017 Federal 1040 or copy of last (most recent) pay stub or
earnings statement from each employer in 2018.
• Award letter from Unemployment Office stating the weekly benefit
amount. (If benefits not received, please explain.)
• Provide estimated income information on page 2 of this form.
• Describe the situation on page 2 of this form.
□ Loss of benefits, such as child
support, alimony, unemployment
benefits, workers’ compensation,
disability benefits, etc.
□ Student
□ Spouse
□ Father
• Letter or other notification stating the date the benefits ended.
• Documentation of the amount of benefits received.
• Provide estimated income information on page 2 of this form.
• Describe the situation on page 2 of this form. If loss of benefits such as
unemployment benefits or workers’ compensation is due to a return to
work, please provide date returned to work, and a copy of most recent
pay stub or earnings statement.
□ Loss of work income due to
illness or injury.
□ Student
□ Spouse
□ Father
□ Mother
• Letter from employer or appropriate medical professional, verifying the
date the employee became unable to work, and an estimate of when the
employee should be able to return to work.
• Copy of last pay stub.
• Provide estimated income information on page 2 of this form. You
must report all income that is received in place of work income, such as
workers’ compensation, disability benefits, etc.
•
Describe the situation on page 2 of this form.
□ Divorce, separation, or death.
□ Spouse
□ Father
• Copy of divorce decree or death certificate (as applicable).
• Copy of 2017 or 2018 IRS Tax Return Transcripts and W2 forms.
• Describe the situation and provide estimated income on page 2.
□ Other loss, reduction or
adjustment to income, such as
unusually high medical expenses, a
one-time disbursement of income or
benefits which changed the family’s
overall income level, etc.
• Submit the appropriate documentation to support your circumstance,
such as a copy of your 2017 or 2018 IRS Tax Return Transcripts
showing the amount of a one-time disbursement of income, or a copy of
Schedule A from your tax return, showing the amount of itemized
medical expenses.
• Provide estimated income information on page 2 of this form.
• Describe the situation on page 2 of this form.
