Revised 03/2015
Copper Mountain College
Financial Aid Office
REQUEST FOR INCOME REDUCTION/ADJUSTMENT
____________________________________________ _________________________
Student Name (Last, First, M.I.) Student ID #
PART I Please submit a typed or a legibly written statement explaining your financial situation in detail. Be sure
to include all relevant information including whom the circumstance affected, the dates the circumstances occurred
and other information that you feel would justify this reduction/adjustment of income. Include last date of
employment, reason for unemployment, date benefits stopped, etc. If you are unemployed and not receiving
unemployment benefits please specify.
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PART II Please check the reason for your reduction (listed below) and provide the appropriate documentation.
_____ Loss of Employment
student spouse mother father
Definition: Since you have completed the Current FAFSA, a member of your family has experienced a loss of
employment due to termination, layoff, disability, retirement, etc.
_____ Change in Employment Status student spouse mother father
Definition: Since you completed the Current FAFSA, a member of your family has had a change of employment
that has resulted in a substantial decrease in household income.
_____ Loss of Untaxed Income or Benefits student spouse mother father
Definition: Since you have completed the Current FAFSA, a member of your family has lost some type of untaxed
income or benefits. Untaxed income includes worker’s compensations, child support, social security benefits,
pensions and annuities, etc.
**Additional Documentation: Agency certification of loss of a benefit or untaxed income
_____ Divorce or Legal Separation student/spouse mother/father
Definition: Since you completed the Current FAFSA, a separation/divorce occurred in your immediate family.
**Additional Documentation: A copy of the divorce decree or a letter from the attorney verifying the separation date
_____ Death of Parent or Spouse
**Additional Documentation: A copy of the death certificate and/or obituary from a newspaper that list you as one
of the surviving family members
Revised 03/2015
_____ Military Discharge student spouse mother father
Definition: You served in a branch of Armed Services and have recently been released from active duty.
**
Additional Documentation: A copy of the release documentation (DD214)
_____
One-time income student spouse mother father
Definition: A member of your immediate family received a significant one-time lump of money that will not be paid
again. (Examples: inheritance, reenlistment bonus, special military pay, retroactive lump sum SS payments, etc.)
**Additional Documentation: Documentation of one-time income including amount and type.
_____ Disability student mother father spouse
Definition: The above member of your family has become disabled which resulted in a loss of employment.
**Additional Documentation: - A letter from the physician stating the nature and date of the disability
- Documents supporting Social Security Benefits of any type expected in the
next twelve months.
Documents required for All the above listed reasons
1. Statement from unemployment office of unemployment benefits, if applicable.
2. Proof of ALL current household income (pay stub, cash aid, SSI, retirement, child support
and/or alimony, a copy of the final divorce decree including settlement agreement, if applicable,
etc.)
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PART III I certify that all information on this form and supporting documentation are true and complete to the best of my knowledge. I
understand it is my responsibility to contact the Financial Aid Office in writing if any of the above information changes.
______________________________________________________________ ___________________
Student Signature Date
______________________________________________________________ ___________________
Parent Signature (for dependent students only) Date
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