FPJSEP
UMGC Financial Aid Office | 3501 University Boulevard East, Adelphi MD 20783 | help.umgc.edu
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Award Year 2019-2020
Dependent Student Special Conditions Appeal Form: Change in Parent Marital Status
Student’s Name: __________________________________
Student’s ID #: ___________________________________
If your family has experienced significant changes in income that occurred on or after 01/01/2018 due to
a change in your parent’s marital status (marriage, separation, divorce), please complete this form.
Before your appeal can be considered, your 2019-2020 Free Application for Federal Student Aid (FAFSA) must
be completed and all required documents must be submitted. UMGC is held accountable for all decisions made
and must be able to fully document why a decision was made to adjust a student’s FAFSA. If an appeal is
incomplete, it will not be reviewed. Submission of an appeal does not guarantee approval of an appeal.
Additionally, approval of an appeal does not guarantee receipt of additional aid. You are responsible for all
outstanding charges with UMGC.
Required Documents: If a document listed below is not applicable to your situation, please submit a signed
statement indicating why you do not have the document.
1. Completed appeal form both pages
2. A typed statement that explains your circumstances in detail – must be signed by hand and dated
3. 2017 Tax Return Transcript for student
2017 Tax Return Transcript(s) for parent(s)
4. 2017 Wage and Income Transcript for student
2017 Wage and Income Transcript(s) for parent(s)
5. If parents are currently married: copy of marriage certificate
If parents are currently divorced: copy of divorce decree
If parents are currently separated: copy of legal separation agreement, or a signed letter from a third
party professional (attorney, clergy, counselor, etc.) on their official letterhead, stating date of
separation
Instructions: Please continue to Page 2 to provide your current household information.
Financial Aid Office Use Only
Date__________________________________
Approved ________ Denied ____________
Signatures ____________________________
_________________ __________________
_________________ __________________
_________________ __________________
Appeal Deadline
Complete appeals for the 2019-2020 academic
year must be received by May 1, 2020.
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Please complete the chart below by listing all people in your parent(s)’ household. Include the name of the
college for any household member who will be enrolled at least half-time in a degree or certificate program at a
postsecondary educational institution any time between July 1, 2019 and June 30, 2020. If additional space is
needed, use an extra page. The definition of “household” includes:
Yourself, even if you don’t live with your parent(s)
Your parent(s) (including a step-parent) regardless of current marital status or gender
Your parent(s)’ other children, even if they don’t live with your parent(s), if your parent(s) will provide
more than half of their financial support from July 1, 2019 to June 30, 2020, or if the other children
would be required to provide parental information if they were completing a FAFSA for 20192020.
Other people who now live with your parent(s), if your parent(s) provide more than half of their support
and will continue to provide more than half of their support through June 30, 2020.
STATEMENT OF CERTIFICATION
All of the information on this form is true and complete to the best of my knowledge. If requested, I agree to provide
further documentation to substantiate the information provided. I understand that all special circumstances are reviewed
on a case-by-case basis and this written request does not guarantee approval and/or may not ultimately result in an actual
change to the financial aid already offered. All persons providing information must sign below.
Student’s Signature ____________________________________________________ Date _______________________
(must be signed by hand, not typed)
Parent’s Signature _____________________________________________________ iDate _______________________
(must be signed by hand, not typed)
Full Name
Age
Relationship
College (student will be enrolled at least half-time)
Self
University of Maryland Global Campus
Parent 1
Parent 2