Office of Financial Aid
Hepburn Hall, Room 215 | 2039 John F. Kennedy Boulevard | Jersey City, NJ 07305
Phone: (201) 200-3173| Fax: (201) 200-3181 | Email: financialaid@njcu.edu
FORM TYPE: SPC
Please log into your Gothic
Portal and upload form to
MY ATTACHMENTS
2020-2021 Request for Consideration of Special Circumstances
The deadline for submission of these Requests is September 1, 2020 if you attend the Fall-2020 semester,
and February 1, 2021 if you attend NJCU starting in the Spring-2021 semester. The review of your
request will not begin until all documentation is submitted and it may take approximately four
weeks to be processed.
Student Name: ____________________________________ Student ID#_________________
All requests for consideration of special circumstances must include:
• Copy of the 2018 Complete IRS tax transcript and W‐2s for the student and parent (if applicable)
• Completed 2020-2021 Verification Worksheet
• Letter explaining in detail the circumstances and the reason for your appeal.
Check the reason (s) that best describes your situation and provide all requested documentation
□ Unemployment: Person’s Name: ____________________________
Relationship to Student_______________________________
• Please write a statement explaining beginning and end date of all employment. Also indicate beginning and
ending date of any unemployment compensation as well as any other sources of income for 2019.
• Copy of the 2019 Complete IRS Tax Return Transcript and W-2s for the student and parent(if applicable)
• Copy of the letter of termination/change in status from the employer stating status date and any
benefits received for each employment listed in above statement.
• Copy of official statement of unemployment eligibility, if receiving unemployment.
□ Disability/Death: Name of disabled or deceased person: ____________________________
Relationship to Student_______________________________
• Please write a statement explaining the circumstances.
• Copy of the letter from the employer stating any benefits received.
• Copy of the 2019 Complete IRS Tax Return Transcript and W-2s.
In the case of disability: copy of official statement of disability benefits, eligibility for workers compensation,
or eligibility for social security benefits
• I
n the case of death: copy of the death certificate or obituary
□ Divorce/Separation: Date of separation or divorce: _________________________________
Relationship to Student___________________________
• Please write a statement explaining the situation including the date of separation as well as beginning and end
date of all employment. Also indicate beginning and ending date of any unemployment compensation as well as any
other sources of income for 2019.
• Copy of the 2019 Complete IRS Tax Return Transcript and W-2s for the student and parent(if applicable)
• In the case of divorce: copy of official divorce decree
• In the case of separation, proof of separate addresses, (i.e. Gas/electric bill), and please address custody, child
support, and alimony in a written statement.
•
□ Other: ____________________________________________________________________________
St
udent Signature: _________________________________________ Date: ______________
Parent Signature (Required for all dependents): _________________________ Date: ______________
