2020-2021 Special Circumstance Request
Form
Monroe Campus Phone 318-345-9005 Fax 318-345-9006
__________________________________________________________________________
This request is used to adjust the income reported on the current year’s Free Application for Federal Student Aid (FAFSA)
due to a change of circumstances during the calendar or academic year. Please adhere to the following:
• LDCC will accept request form along with all required documentation.
• Attach 2018 and 2019 IRS Tax Return.
• Completed forms will be reviewed within 15-20 business days.
Student’s Name _________________________________ ID # _________________ DOB _____________
Best Contact Phone # ___________________________ Semester: ___ SUM20 ___FA20 ___SPR21
STEP 1: All students MUST submit the following documentation, regardless of their reason for filing a Special
Circumstance Request.
Student’s current check stub (if employed)
Father’s current check stub (if employed)
Mother’s current check stub (if employed)
Current check stubs or statements for all
Student’s current check stub (if employed)
Spouse’s current check stub (if employed)
Current check stubs or statements for all
untaxed benefits
In addition to the current check stub(s), the following documentation is also required:
LOSS OF EMPLOYMENT OR REDUCTION IN PAY/HOURS - Student/Spouse/Parent was working during 2018 or 2019
but is now working fewer hours or is unemployed.
• Loss of Employment is when a student/parent is laid-off or dismissed from work.
• Loss of Employment does not mean you voluntarily quit
your job.
The following documentation is required from the unemployed household member:
Last check stub(s) from previous employer during 2018 and 2019
Letter from previous employer stating date of termination or reduction in pay and/or hours
Benefit or denial letter from Unemployment Office
LOSS OF BENEFITS - Student/Spouse/Parent has lost some or all benefits. The following documentation is required:
Last check stub(s) or printout of benefit(s) received during 2018 and 2019
Letter from agency verifying date and amount of benefit(s) lost
DEDUCTION OF ONE-TIME PAYMENT - Student/Spouse/Parent received a ONE-TIME PAYMENT (pension, IRA,
annuities, gambling winnings, settlement, etc.). The following documentation is required:
Receipt(s) showing where one-time payment was spent
Copy(s) of bank account statements
Statement from agency to verify one-time payment and to indicate no future payments expected
SEPARATION OR DIVORCE - Student/Parent was married when the FAFSA was filed but has now separated or
divorced. The following documentation is required:
Court documentation verifying legal separation or divorce if provided by your state
If no legal separation can be provided, submit the following:
1. Notarized statement by parent or independent student indicating date of separation.
2. Two bills (utility and telephone bills) from each parent or independent student and spouse showing
different addresses.
School Code 041301 / Campus Attending
____ Monroe ____ Bastrop ____Jonesboro ____ Lake Providence ____ Ruston ____ Tallulah ____ West Monroe ____ Winnsboro
