Award Year 2020-2021 FPJUNT
UMGC Financial Aid Office | 3501 University Boulevard East, Adelphi MD 20783 |
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Dependent Student Special Conditions Appeal Form: Loss of Benefits or Untaxed Income
Student’s Name: __________________________________
Student’s ID #: ___________________________________
If your family has experienced significant changes in income that occurred on or after 01/01/2019 which merit
recalculating your financial aid eligibility based on your projected annual 2019 income rather than the federally-
required 2017 income, please complete this form. You must be able to document that the reduction of income
has occurred for a period of at least ten weeks prior to submitting the appeal.
Before your appeal can be considered, your 2020-2021 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. 2018 Tax Return Transcript for student
2018 Tax Return Transcript(s) for parent(s)
4. 2018 Wage and Income Transcript for student
2018 Wage and Income Transcript(s) for parent(s)
5. Documentation of benefits termination from the provider and/or date of change. Examples include: letter
from the Social Security Administration or the Department of Social Services, divorce decree, court
order, DD-214
INSTRUCTIONS: Please provide all information requested in the following sections. If any are left incomplete,
your appeal will not be reviewed.
Part 1: List all asset information as of the date you initially filed your 2020-2021 FAFSA:
Total cash, savings, and checking account balance(s): $_________________________Balance
Financial Aid Office Use Only
Approved ________ Denied ____________
Signatures ____________________________
_________________ __________________
_________________ __________________
_________________ __________________
Appeal Deadline
Complete appeals for the 2020-2021 academic
year must be received by May 1, 2021.
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Part 2: List all projected annual income and benefits from January 1, 2020 to December 31, 2020.
SOURCE OF INCOME (projected until end of the year) PARENT 1 PARENT 2 STUDENT
Wages, salaries, tips (including severance pay) $ $ $
Pensions and Annuities $ $ $
Interest and /or Dividend Income $ $ $
Business/farm Income $ $ $
Unemployment Compensation $ $ $
Alimony $ $ $
Social Security/SSI Benefits $ $ $
Workers Compensation $ $ $
Disability Benefits $ $ $
Retirement Benefits $ $ $
Child Support $ $ $
Welfare Benefits/ TANF $ $ $
Other Untaxed Income $ $ $
$ $ $
Part 3: 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, 2020 and June 30, 2021. 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, if your parent(s) will provide more than half of their financial support
from July 1, 2020 to June 30, 2021, or if the other children would be required to provide parental
information if they were completing a FAFSA for 20202021.
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, 2021.
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