Fillable Form 20202021: Special Circumstance Reevaluation Request Form (Haskell Indian Nations University)

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Form 20202021: Special Circumstance Reevaluation Request Form (Haskell Indian Nations University)

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The Form 20202021: Special Circumstance Reevaluation Request Form (Haskell Indian Nations University) form is 2 pages long and contains:

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  • 19 check-boxes
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Country of origin: US
File type: PDF

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Haskell Indian Nations University
Financial Aid Office
155 Indian Avenue, Box 5027
Lawrence, KS 66046
Phone: (785) 749‐8468
Fax: (785) 832‐6617
1 | P a g e S p e c i a l C i r c u m s t a n c e s F o r m
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2020‐2021
Special Circumstance Re‐evaluation Request Form
When a student and/or their families experience a change in circumstances (such as a loss of income or an increase in non‐
discretionary expenses), the income information, which was provided on the free Application For Federal Student Aid
(FAFSA) or the cost of attendance established by the Financial Aid Office, may no longer accurately reflect the real financial
situation. In some cases, the Financial Aid Office may be able to adjust income information of the cost of attendance based
on these “Special Circumstances”. Adjustments to income or cost of attendance, however, do not guarantee that additional
financial aid will be awarded.
Student’s Name: Student ID:
Phone Number: Email address:
Were you required to provide parental information? Yes No
If you experienced one or more of the following changes in your income or expenses, re‐evaluation of your 2020‐2021
financial aid award package may be possible (Please check all that apply):
Loss of Income
Job Termination Child Support Paid
Job Change Medical Expenses
Reduced Hours Dental Expenses
Disability Nursing Home
Retirement Funeral Expenses
Divorce Required Education Expense
Separation Transportation Expenses
Death of Spouse
Loss or Reduction of Social Security
Benefits, Child Support or Alimony
Please write or type a brief narrative detailing the circumstances leading to the request for re‐evaluation. Please be very
specific in your narrative (i.e., provide dates, names of employers, if applicable) so that we can be specific with our requests
for documentation. If you need additional space or prefer to type your narrative. Please attach a separate page. Our staff
will then send a request detailing the documentation needed to process your re‐evaluation. Examples of requested
documentation may include federal income tax documents, employment termination letters, paystubs, copies of paid bills
or receipts, court documents and other document as necessary.
Haskell Indian Nations University
Financial Aid Office
155 Indian Avenue, Box 5027
Lawrence, KS 66046
Phone: (785) 749‐8468
Fax: (785) 832‐6617
2 | P a g e S p e c i a l C i r c u m s t a n c e s F o r m
Your Special Circumstance Request will be re‐evaluated only after the original FAFSA and all supporting documents have
been reviewed. If your special circumstance re‐evaluation results in increased eligibility for aid and funds are available, you
may receive additional assistance. If the documentation you submit to the Financial Aid Office results in reduced eligibility
for financial aid, however, you may be required to repay aid and/or previously awarded aid may be cancelled or reduced. If
you cannot provide documentation for your income projections (if applicable) you may be asked to resubmit your
request at the end of the 2018 tax year, when tax documents will be available.
Due to processing schedules, requests may not be reviewed during the following periods (if you have
any questions, please contact the financial aid staff):
• July 15, 2020 through September 15, 2020
• January 1, 2021 through February 15, 2021
Deadline to submit request and all supporting documentation:
• April 1, 2021
Submit completed requests to the following address:
Haskell Indian Nations University
Financial Aid Office
155 Indian Avenue, Box 5027
Lawrence, KS 66046
Al
l Special Circumstance Re‐evaluation Requests are subject to review and verification of your original Free Application for
Federal Student Aid (FAFSA).
I un
derstand that verification of my projections may be required at the end of the current year. If I underestimate my
projected income or if I overstate my projected expenses
, I understand that I may be required to repay aid. I affirm that all
of the information on this form is true and complete to the best of my knowledge. If I am asked by an authorized official to
document actual earnings or expenses for the prior or following year from the current FAFSA year verified, I will provide the
information. I agree to provide proof of all information on this form, which may include but is not limited to: copies of
federal tax returns, schedules, and W‐2 forms for 2018.
Student Signature:
Date:
Print Name: Date:
Parent Signature: Date:
If you are an Independent student, a parent signature is not required.
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Completed 1 February 2021

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