Required Documentation for Extenuating Circumstances
**Required for ALL Requests – 2019 & 2020 Federal Tax Return and Verification Worksheet**
1. Loss of employment or change of employment status (Attach the following).
Consideration will be given after July 1, 2021.
Signed statement from student (or parent) explaining the reason for unemployment or change of
employment.
Last pay stub showing year to date earnings for 2021 or statement from previous employer
documenting year to date income.
Include final and/or last pay stubs from all places of employment during 2021 for student and
spouse (if applicable) and parent(s) (if dependent student).
Documentation of all untaxed income received for 2021.
2. Divorce or separation of student or parent (Attach the following).
Divorce – Copy of divorce Decree
Separation – Copy of legal separation documentation, or signed statement from an attorney
showing the date of separation, or a notarized statement from an unrelated third party.
3. Death of a spouse or parent (Attach the following).
Copy of death certificate or obituary notice
4. Loss of Untaxed Income (Attach the following).
Signed statement from student (or parent) explaining the reason for lost income.
Copy of a letter from the agency that provided benefits detailing termination and summary of
benefits.
5. Unusual medical or dental expenses or handicapped related expenses (Attach the following).
Copy of Schedule A of the 2019 federal tax return.
Cancelled checks and/or receipts for PAID expenses that were not reimbursed by an insurance
agency.
Statement from insurance agency indicating expenses were not reimbursed.
6. Onetime payments which over inflated annual income. Onetime payments used for frivolous or
unnecessary items are not valid and will not be considered. (Attach the following).
Detailed written explanation indicating: 1) type of payment, 2) gross payment amount, 3) net
payment received and 4) how this payment was used.
7. Other (Attach the following).
Signed statement from student (or parent) explaining the circumstances.
Pertinent documents supporting your request for reconsideration.
I certify that the above information is true and correct to the best of my knowledge. I understand that purposely
providing false or misleading information on this form may result in a denial or repayment of financial aid in this
and/or future years, or fines and/or imprisonment.
Student Signature: _____________________________________ Date: __________________
Parent Signature:______________________________________ Date: __________________
(Dependent Students)
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