Fillable Financial Aid Appeal Application (Cornell University)

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Financial Aid Appeal Application (Cornell University)

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203 Day Hall | Ithaca, NY 14853-2801 | t. 607-255-5145 | e. finaid@cornell.edu
Office of Financial Aid and
Student Employment
Submit this form:
Secure Upload at http://finaid.cornell.edu
Secur
e Fax: 607-255-6329
Financial Aid Appeal Application
Student Name: Parent 1 Name:
Student Phone: Parent 2 Name:
Cornell ID: NetID: Parent E-mail:
Check one: Early Freshman Regular Freshman Parent Phone:
Transfer Current Student
Complete this application and return to our office with the additional documentation requested, if required. The Appeal Application will
not be reviewed until all documentation is received. Depending on the time of year your appeal is received, the Office of Financial Aid
and Student Employment reserves the right to postpone the review of special circumstances until the next academic year’s financial aid
review.
Please
check
Reason for Appeal
Required Documentation
Significant loss in income due to
termination or change in employment
Please note:
*the earliest we
will consider an appeal
due to unemployment is generally 8
weeks from the date of termination
*changes may not be considered if
income loss for the year is not significant
*you must notify the Office of Financial
Aid and Student Employment if you
become re-employed before the end of
the year
Termination or change of employment:
Copy of the last/most recent pay stub for both parents in the
hou
sehol
d
Termination notice or letter of explanation from employer
S
everance statemen
t
C
opy of unemployment benefit eligibility from Dept. of Lab
or
In
come, Expense, and Bene
fit Worksheet (attached)
Last day of employment/termination date:
Date of change in employment:
Termination or reduction to untaxed benefits, including Social Security, child
support, disability:
Documentation of reduction
Explanation for change from granting authority
U
nexpected life event
*please note that in a divorce situation,
we
will continue to consider bot
h
c
ustodial and noncustodial
parent
s’
i
ncome and asset informati
on
Death of parent or other immediate family member:
Documentation of medical and/or funeral expenses
I
f decrease in income, complete the Income, Expense, and Benefi
t
Worksheet (attached)
D
ocumentation of expected Social Security benefits for all famil
y
me
mber
s
D
ocumentation of other distributions from inheritance, assets, o
r
ot
her benefit sources including life insuranc
e
C
orrection to income or asset
information reported
Detailed description of error and correction
Documentation of correct amount (for example, if mortgage value
a
nd debt was misreported, a copy of the mortgage statement a
nd
m
ost recent assessment of home should be sent
)
M
ore favorable award from another
institution
Copy of Financial Aid Notification from the institution.
NOTE: Cornell will only review
financial aid offers from any of the Ivy
League institutions, Stanford University, Duke University, and MIT.
NOTE: Early Decision Freshman cannot appeal for this reason.
203 Day Hall | Ithaca, NY 14853-2801 | t. 607-255-5145 | e. finaid@cornell.edu
Please
check
Reason for Appeal
Required Documentation
High medical, educational, or family
expenses
Medical:
Documentation of medical expenses paid during prior tax
year that exceed 10% of your Adjusted Gross Income
NO
TE: Explanation of Benefits from insurance provider is not acceptable
document
ation
Educational (undergraduat
e):
Documentat
ion from school showing enrollment status and
expected graduation date
Educational (support for a full-time student in Graduate/Medical/Law
School):
Copy of Financial Aid Notification indicating required parent
contribution
Detailed listing/documentation of support to student provided
during the academic year
Family:
Documentation of support to relatives outside of the immediate
family (cancelled checks, wire transfer records, statement from
recipient indicating amount received, etc.)
Other reason not listed
Please provide a detailed description of the basis of appeal and
documentation supporting your request for reconsideration
NOTE: we are unable to consider appeals based on circumstances that
include but are not limited to:
High consumer debt
P
ersona
l Expenses (pets, cars, housekeepers, vacations, sports, etc.)
Fraternity or Sorority expenses
Expenses that have not yet occurred
Student/Parent Certification
Ink S
ignatures required by parent and student
I/We certify that, as of the date this application is signed, the information included herein is true and accurate to the best of my/our
knowledge and is not falsely represented.
I/We understand that the submission of an appeal does not release the student from the obligation of staying current with the Bursar
and/or Cornell Card bill. I/We understand that as there is no guarantee that an appeal will be approved, it is the student's responsibility to
maintain good standing with the Bursar and his/her college registrar.
I/We affirm that the information provided on this form and attached documentation is accurate and complete to the best of our
knowledge. I/We understand that completing this form does not guarantee financial aid will be increased. I/We also understand that any
revision based on this appeal information does not guarantee the same adjustments will be made in future semesters and/or academic
years.
I/We understand the appeal will be reviewed within 7-10 business days of receipt by the Office of Financial Aid and Student Employment
(FASE) and that additional processing time may be necessary in the event more information is requested by FASE. I/We understand the
parent and/or student may be notified via mail and/or e-mail with the outcome of the appeal decision.
Signature of Parent(s): Date:
Signature of Student: Date:
203 Day Hall | Ithaca, NY 14853-2801 | t. 607-255-5145 | e. finaid@cornell.edu
Office of Financial Aid and
Student Employment
Submit this form:
Secure Upload at http://finaid.cornell.edu
S
ecure Fax: 607-255-6329
Income, Expense and Benefit Form
All parts of this form are required. If a particular question does not apply, fill in with a N/A or zero.
Student’s Name: Cornell ID Number:
(l
eave blank if unk
nown)
Parent 1 Name: Par
ent 2 Name:
Stud
ent’s Date of Bi
rth: Today’s D
ate:
Benefits:
Indicate a monthly dollar amount next to the benefits that your family receives (if applicable):
Benefit
Current Monthly Amount
Housing Assistance (HUD, Section 8)
$
Food Stamps (SNAP, TANF, etc)
$
Utilities Assistance (HEAP)
$
Free/Reduced Lunch
$
Other
$
Support from Others:
Indicate a monthly dollar amount that the family receives in support from others (friends, family, church, etc):
$
Monthly Expenses:
Indicate only the amount that family is responsible for (cost – any benefit)
Expense
2019 Monthly
Amount
2020 Monthly
Amount
Out of Pocket Medical
Expenses (copay, insurance)
Education (siblings to student only)
Other (specify):
Other (specify):
Total:
Monthly Income:
Income Source
2019 Monthly
Amount
2020 Monthly
Amount
Net Wages
Net Rental / Business Income
Unemployment Benefits
Disability / SSI Benefits
Child Support
IRA, Pension, Annuity withdrawals from Retirement
Other (specify):
Other (specify):
Total:
Total plus support from others and benefits:
Explanation (required)
Certification:
By signing this statement, we certify that all the information reported on this form is complete and accurate. At least one
parent must sign if you are a dependent student.
Student Signature:
Parent Signature:
203 Day Hall | Ithaca, NY 14853-2801 | t. 607-255-5145 | e. finaid@cornell.edu
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Financial Aid Appeal Application (Cornell University)

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Completed 18 April 2021

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