Fillable Form 1.: 2021-2022 Request for Consideration of Special (CSN)

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Form 1.: 2021-2022 Request for Consideration of Special (CSN)

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The Form 1.: 2021-2022 Request for Consideration of Special (CSN) form is 4 pages long and contains:

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  • 14 check-boxes
  • 76 other fields

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W. CHARLESTON CAMPUS
N. LAS VEGAS CAMPUS
HENDERSON CAMPUS
RURAL CAMPUSES
CFSPEC
Student Name: NSHE ID:
Sometimes families experience circumstances, which merit recalculation of their financial aid eligibility based on 2020 tax year
information rather than the federally required 2019-tax information. This form is designed to document those situations
for review by the Office of Financial Aid. Please be advised that all Professional Judgment appeal decisions are final.
Section 1: INSTRUCTIONS
1.
Complete and submit the Free Application for Federal Student Aid (FAFSA) for the current Award Year (i.e., 2020
-2021 or 2021-2022);
2.
Complete and submit this Request for Consideration of Special Circumstances Form to the Office of Financial Aid;
3.
Complete and submit a Student Verification Worksheet, Group 1
*Submit a copy of your 2019 and 2020 Tax Return Transcript (*2021 if after January 31
st
) and your parent’s 2019
and 2020* Tax Return Transcript (if a dependent student);
*Submit a copy of your/your spouse’s (if married) 2019 and 2020 Tax Return Transcript (2021 if after January 31
st
)
4.
Submit a typewritten, signed letter explaining your situation
Section 2: CIRCUMSTANCES
Please check [ √ ] the box beside the circumstances that apply to your situation and submit the required paperwork.
Separation from Employment due to Layoff, Termination, or Disability for at least 10 weeks in 2020/2021
*
Letter from employer on company’s letterhead including last date of employment
*
Unemployment benefits determination document (if applicable)
*
Documentation of income for 2020/2021 (Tax Return Transcript), and ALL W-2/1099's
Excessive non-reimbursed medical and/or dental expenses
*
Documentation of non-reimbursed medical and/or dental expenses OR
*
Canceled checks verifying payments made in 2020/2021 OR
*
Copy of Schedule A Form from 2020/2021 Federal Income Tax Return
Loss or Reduction of 2020/2021 Income Source (one-time income, disability benefits, welfare benefits, child support)
*
Copy of Notification of benefits reduction/termination, including the effective date
*
Documentation of 2020/2021 income (taxable and non-taxable)
*
Letter explaining the type and amount of one-time income received in 2019 and not 2020/2021.
Separation or Divorce which occurred AFTER applying for financial aid
*
Copy of court order, final divorce decree or legal separation agreement
*
W2/1099 statements from both parties and a 2020/2021 Tax Return Transcript for both parties
Death of a parent (or spouse) which occurred AFTER applying for financial aid
*
Copy of death certificate
Other Unusual Circumstances
*
Please attach a detailed statement and include copies any additional documentation you would like
the Financial Aid Administrator to consider if your family circumstances were not reflected above.
OFFICE OF FINANCIAL AID
2021-2022 Request for Consideration of Special Circumstances
W. CHARLESTON CAMPUS
N. LAS VEGAS CAMPUS
HENDERSON CAMPUS
RURAL CAMPUSES
CFSPEC
Section 3: CERTIFICATION
I/we certify that the information provided on this form is complete and accurate to the best of my/our knowledge. I/we agree to provide
more detailed documentation if required. If additional changes occur during the academic year that would alter the information provided on
this form, I/we would immediately contact the Financial Aid Office at College of Southern Nevada.
I / We understand that failure to provide the required documentation will result in denial of this appeal. One parent signature is required
if you are a dependent student. Purposely giving false or misleading information may result in federal fines, jail sentence, or both.
_ _
Student’s Signature Date Spouse’s Signature (if married) Date
_ _
Parent 1 Signature (if dependent) Date Parent 2 Signature (if dependent) Date
OFFICE OF FINANCIAL AID
2021-2022 Request for Consideration of Special Circumstances
FOR OFFICE USE ONLY – DO NOT WRITE IN THIS SPACE
PJ Approved? Student Notified? Verification Complete? ISIR Updated? TR number
Old EFC: New EFC:
Comments:
FAA Signature: Date:
OFFICE OF FINANCIAL AID
2021-2022 Verification Worksheet 1
CFVWV1
Your 2021–2022 Free Application for Federal Student Aid (FAFSA) has been selected for the process called Verification. You must complete
and sign this worksheet, attach any required documents, and submit them to the Financial Aid Office. After review, we may ask for
additional information.
A. STUDENT INFORMATION
NSHE (Student) ID LAST NAME FIRST NAME M.I.
B. HOUSEHOLD/FAMILY INFORMATION
DEPENDENT STUDENT – A student is considered Dependent, if he/she was required to provide parental data on the FAFSA.
Please include in your household (below) the following:
•
You and your parents/stepparents (who provide more than half of your financial support) even if the student does not live with parents.
•
Your parent/stepparents’ dependent children, if your parent/stepparents’ will provide more than half of the children’s support from
July 1, 2021 through June 30, 2022, or if the children would be required to provide parental information if they were completing a
FAFSA for 2021-2022. Include children who meet either of these standards, even if a child does not live with the parents.
•
List other people as part of your household only if they now live with your parents AND they provide more than half of their support
AND will continue to provide more than half of their support through June 30, 2022.
INDEPENDENT STUDENT – A student is considered Independent if he/she was NOT required to provide parental data on the FAFSA.
Please include in your household (below) the following:
•
You and your spouse, if married.
•
The student’s or spouse’s children if the student or spouse will provide more than half of the children’s support from July 1, 2021
through June 30, 2022, even if the child does not live with the student.
•
List other people as part of your household only if they now live with you and you provide more than half of their support and will
continue to provide more than half of their support through June 30, 2022.
COLLEGE INFORMATION: If any household member will be attending college at least half-time between July 1, 2021 and June 30, 2022
and will be enrolled in an eligible degree or certificate program, write the full name of the college or university (do not abbreviate).
Full Name
Relationship
College Name (do not abbreviate)
Self
College of Southern Nevada
**If more space is needed, please provide an additional page with the student’s NSHE ID and name at the top of the page.
**CSN may require additional documentation if we have reason to believe that the information regarding the household members enrolled in an eligible
post-secondary institution is inaccurate.
W. CHARLESTON CAMPUS N. LAS VEGAS CAMPUS HENDERSON CAMPUS RURAL CAMPUSES
OFFICE OF FINANCIAL AID
2021 - 2022 Verification Worksheet 1
C. INCOME VERIFICATION
Complete this section if you (your spouse, if married) and/or your parents (if you are a dependent student) filed a 2019 income tax
return with the IRS.
Student/Spouse Parent(s)
I/We have successfully used the FAFSA’s IRS Data Retrieval
Tool.
I/We have successfully used the FAFSA’s IRS Data Retrieval
Tool.
I/we am/are unable or chose not to use the FAFSA’s DRT to
transfer my/our income information. I have attached a
copy of my/our Tax Return Transcript here.
I/we am/are unable or chose not to use the FAFSA’s DRT to
transfer my income information. I have attached a copy of
my/our Tax Return Transcript here.
I/we did not and am/are not required to file a 2019 Federal
Tax Return and will complete Sections D and E (if
applicable) below.
I/we did not and am/are not required to file a 2019 Federal
Tax Return and will complete sections D and E (if
applicable) below.
D. TAX RETURNS – NON FILERS
Complete this section if you, the student (and spouse, if applicable) and/or your parent(s) (if dependent) will not file and are not required
to file a 2019 income tax return with the IRS, but earned income from work in 2019. If you are required to file a return, but have not, you
must file your return in order to be considered for Federal Student Aid.
In the following table, please list all earnings from work during 2019 and attach a 2019 W2 or 1099-MISC for each line item. Your application
cannot be considered complete until all earnings from work can be verified with a W2 or 1099-MISC.
Source of Income from Work in 2019
Student Spouse/Parent(s)
IRS W-2 or
1099 Attached?
Example: Tom’s Auto Shop
$
$ 5,500
Yes or No
$
$
Yes
No
$
$
Yes
No
$
$
Yes
No
$
$
Yes
No
$
$
Yes No
E. VERIFICATION OF NON-FILING STATUS
If you (and your spouse, if applicable) and your parent(s) (if dependent) did not have any source of income from work in 2019 (i.e. did not
file a tax return and no income was listed in Section D), please complete the Dependent Student Support Form or Independent Student
Support Form (as appropriate) and submit a Verification of Non-filing letter from the IRS.
F. CERTIFICATION AND SIGNATURE(S)
I certify that all of the information reported on this worksheet is complete and correct. The student and one parent must sign this
worksheet. If you purposely give false or misleading information, you may be fined, sent to prison, or both.
Student’s Signature Date Parent’s/Spouse’s Signature Date
W. CHARLESTON CAMPUS N. LAS VEGAS CAMPUS HENDERSON CAMPUS RURAL CAMPUSES
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Form 1.: 2021-2022 Request for Consideration of Special (CSN)

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Completed 30 June 2022

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