Fillable FAC19PJD (Howard Community College)

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FAC19PJD (Howard Community College)

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2019/2020
Dependent
Professional Judgment
A. Student’s Information
Student’s Last Name Student’s First Name
Student’s M.I. Student’s HCC ID Number
EXPLANATION OF CIRCUMSTANCES
On a separate sheet, explain your circumstances, including specic dates and details.
SELECT REASON FOR PROFESSIONAL JUDGMENT SUBMIT REQUIRED DOCUMENTS
Death of parent(s) after ling the 19/20 FAFSA.
Date of death:
Copy of the death certicate
Copy of the birth certicate (if one parent is listed on birth
certicate and 2nd parent is unknown or estranged)
Separation or divorce of parent after ling the 19/20 FAFSA.
Date of marital separation:
(month/year)
Parent 1 2017 W2(s) Parent 2 2017 W2(s
copy of separation agreement, divorce decree, or substantial
evidence (mortgage/lease/utility bill) proving parents live in
separate residences
is unemployed or
has an income reduction of at least 20% after Jan. 1, 2018.
Date of unemployment/income reduction:
(month/year)
Is above-named student/parent employed now?

Yes No
Date of new employment:
(month/year)
IF 2018 tax return reects current nancial situation:
Submit signed copy of 2018 1040 form: Parent(s) Student
Submit 2018 W2s or 1099s: Parent(s) Student
IF 2018 tax return does not reect current nancial situation:
Complete the 2019 Estimated Income worksheet on page 2.
Termination letter
Last 3 pay stubs from former employer
All unemployment benets received in 2019.
(Ex. Copy of severance/ benets/unemployment compensation)
Most recent 3 pay stubs from current employer
For professional judgments processed after Jan.31, 2020, the
following additional documents may be required:
2019 W2s or 1099s of: Parent(s) Student
Submit signed copy of 2019 1040 form: Parent(s) Student
2020 Estimated Income
Loss or reduction of untaxed income after January 1, 2018
(ex. IRA conversion, loss of child support, etc.)
Date of change:
Attach documentation. (Example: Ocial documentation of
termination of benets)
Unusual medical and dental expenses (Expenses paid in
2018, not covered by health/dental insurance.)
Attach supporting documentation.
(Example: Proof of payment, receipts).
Student dependency status change due to marriage after
ling the 2019-2020 FAFSA
Date of marriage:
Marriage Certicate
Parent of dependent student is also attending college at
least half time. Parent’s Name:
College Program of Study
Other
Documentation:
PRINT
RESET FORM
Certication and Signature
Each person signing below certies that all of the information reported is complete and correct. If student is
dependent, the student and one parent whose information was reported on the FAFSA must sign and date.
Student’s Signature
Date
Parent’s Signature Date
WARNING: If you purposely give false or misleading information, you may be ned, sent to prison, or both.
Financial Aid Services
10901 Little Patuxent Pkwy 443-518-1260
Columbia MD 21044 443-518-4576 (fax)
CRI: FAC19PJD
Im
ageNow Doc type: UG Finaid Veri ication
FA Doc Name: Professional Judgment
Work Flow Main: FAS Document Processing
Work Flow Sub-queue: Academic Year
2019—OTHER RESOURCES TYPE OF SUPPORT WHO RECEIVES THE SUPPORT?
AMOUNT EXPECTED IN 2018
Provide information about any
other resources, benets, and
other amounts received by the
student and any members of
the student’s household.
Legal Settlement
$
Medical Assistance
$
SSI/SSDI
$
Savings
$
SNAP
$
WIC
$
Total $
Estimated Income your family expects to receive from January 1, 2019 through December 31, 2019
WHAT IS YOUR AND YOUR PARENTS’ 2019 ESTIMATED GROSS TAXABLE INCOME?
STUDENT PARENTS
YTD (year to date) earnings from pay stubs in 2019
$ $
2019 Estimate Earnings:
Student: Average earnings per pay period in 2019 = X No. of pay periods remaining in 2019 =
Parent: Average earnings per pay period in 2019 = X No. of pay periods remaining in 2019 =
$ $
Add 2019 YTD earnings + 2019 estimated future earnings = Total estimated wages for 2019
$ $
Do you or your parents receive money from pensions and annuities? No Yes $ $
Do you or your parents have income from Interest, dividends, and capital gains? No Yes
$ $
Do you or your parents have business or farm income? No Yes
$ $
Do you or your parents receive taxable Social Security benets ? No Yes
$ $
Do your parents have rental income (after expenses such as mortgage interest, taxes, insurance)? No Yes
$ $
Does your parent receive Alimony? No Yes
$ $
Do you or your parents receive unemployment compensation No Yes
$ $
Do you or your parents receive any other taxed income, e.g., severance pay? No Yes
$ $
Total 2019 Estimated Taxed Income (1–9)
$ $ $
WHAT IS YOUR AND YOUR PARENTS’ 2019 ESTIMATED UNTAXED INCOME?
STUDENT PARENTS
Money received by student (do not include money received from parent listed on FAFSA)
$ $
Money paid on student’s behalf (e.g., bills)
$ $
Payment to tax-deferred pension and savings plans (from W-2 forms in Boxes 12a –12d, codes D,E,F,G,H and S)
$ $
Deductible IRA and/or Keogh, SEP, and SIMPLE payments
$ $
Child Support received for all children
$ $
Tax-exempt interest income
$ $
Untaxed portions of IRA distributions
$ $
Living and housing allowances for clergy, military and others*
$ $
Veteran’s Non-educational benets**
$ $
Any other untaxed income and benets not reported elsewhere on this form***
$ $
Total 2019 Estimated Untaxed Income (1–10)
$ $ $
In sections A and B, report estimated income before exemptions, adjustments, or deductions.
If there will be no income in a category, enter “0.
”
*
Include cash payments or cash value of benets. Exclude rent subsidies for low-income housing. Members of the military should only report their total BAS benets for 2018.
Do not report any military housing benets (BAH, BAQ, or the value of on-base military housing).
** Include Disability, Death Pension, or Dependency & Indemnity Compensation (DIC) and /or VA Educational Work-Study allowances
*** Include untaxed income such as workers’ compensation, disability benets, Black Lung Benets, untaxed portions of health savings accounts, Railroad Retirement benets, etc.
NOTE: If you are submitting a 2018 tax return transcript, do not complete this step.
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FAC19PJD (Howard Community College)

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Completed 22 July 2020

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