Fillable FormPSPEC Financial Aid Form

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FormPSPEC Financial Aid Form

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WARNING: If you purposely give false or misleading information, you may be fined, sent to prison, or both.
(v. 12/14/2018) Page 1 of 4 (S:\20_Forms\formPSPEC.wpd)
FORM PSPEC - IDAHO STATE UNIVERSITY 19-20
SPECIAL CIRCUMSTANCES
PARENT(S)
According to federal laws and regulations, a family's 2017 income is used to assess
financial need for the 2019-2020 school year. If a family's financial situation changes, a
financial aid administrator may be able to reassess the financial need using 2019
income. Please read instructions below. Return completed form with attachments to:
Office of Financial Aid, Idaho State University, Museum Building, Room 337
921 S 8
th
Ave, Stop 8077, Pocatello, ID 83209-8077
Phone: (208)282-2756 Fax: (208)282-4755 Email: finaidem@isu.edu
Web: https://www.isu.edu/financialaid/forms/
University Place, Bennion Student Union Building, Student Services Office
1784 Science Center Dr, Idaho Falls, ID 83402 Phone: (208)282-7704
PSPEC-20
*Student Name:
(Use blue or black ink) Last First M.I.
*ISU ID: *Last 4 Digits of Social Security #:
(Find under Academic Tools tab on BengalWeb)
*Parent Name:
Last First M.I.
Parent Address:
Street City St Zip
Parent Telephone: Student ISU Email:
*Required (example: smitjohn@isu.edu)
INSTRUCTIONS:
1. You must have been awarded from the 2019/2020 FAFSA
before we can process the Special Circumstance.
2. Indicate the reason(s) for your reduction in income on page 2 and attach any required documentation.
3. Write a brief summary of your special circumstances on page 3 and complete the signature requirements.
4. Complete page 4 and attach documentation of income.
5. SCHEDULE AN APPOINTMENT WITH A FINANCIAL AID COUNSELOR. Call the Office of Financial Aid at
(208)282-2756, or come to our office in room 337 of the Museum Building, to schedule an appointment. If you are
a student on the Idaho Falls campus, call (208)282-7800, or come to the Bennion Student Union Building Student
Services Office.
For Office Use Only
Prior year special circumstance: Yes No Student log completed:
‘ Not eligible for special circumstances Comments:
‘ Special circumstance denied
‘ Special circumstance approved
Old EFC:
New EFC:
Administrator: Date:
You must bring your completed special circumstance form and all required documentation to your
appointment. Your special circumstances will not be considered unless you provide adequate, appropriate
documentation and meet with a counselor from the Office of Financial Aid.
Please fill in blanks, print, sign, attach docs & return
Press tab or shift-tab to move between fields
Parent Special Circumstance PSPEC
WARNING: If you purposely give false or misleading information, you may be fined, sent to prison, or both.
(v. 12/14/2018) Page 2 of 4 (S:\20_Forms\formPSPEC.wpd)
Please indicate the reason(s) for your parent(s) change in income or unusual expenses. Mark all that apply and
attach the required documentation
.
‘ Loss of income from work.
‘ Layoff. Provide a letter from employer stating effective date and anticipated return.
‘ Business Closure. Provide a letter from employer stating effective date or unemployment application.
‘ Termination. Provide a letter from employer stating effective date.
If this is not available, provide documentation from local unemployment office.
‘ Disability. Date of disability (mm/dd/yyyy): . Attach documentation of disability.
‘ Quit or reduced employment to attend school. Provide a letter from employer stating effective date.
‘ Were self-employed but are now unemployed due to economic conditions or natural disaster.
‘ Other. Please specify and provide appropriate documentation.
‘ Loss of taxable income.
‘ Alimony. Provide court document(s) stating termination date of benefit.
‘ Unemployment. Provide a letter from the unemployment office stating termination date of benefit.
‘ Other. Please specify and provide appropriate documentation.
‘ Loss of untaxed income.
‘ Child support. Provide a letter or court document stating termination date of benefits or a reduction in
benefits.
‘ Worker’s compensation. Provide a letter from Bureau of Worker’s Compensation stating termination
date of benefit.
‘ Other. Please specify and provide appropriate documentation.
‘ Divorce. Since applying for financial aid, you have become divorced.
Date of divorce
(mm/dd/yyyy): . Give only your information when completing page 4.
Attach a copy of the divorce decree, a signed copy 2017 Federal Tax Return, and W-2 form(s).
‘ Separation. Since applying for financial aid, you have become separated.
Date of separation
(mm/dd/yyyy): .
Current address of spouse:
.
Give only your information when completing page 4. Attach a signed copy of your 2017 Federal Tax Return and W-2
form(s).
‘ Death of spouse. Since applying for financial aid, your spouse has died.
Date of death
(mm/dd/yyyy): . Provide documentation.
Give only your information when completing page 4. Attach a signed copy of your 2017 Federal Tax Return and W-2
form(s).
‘ One-time income (i.e. inheritance, moving expense allowance, back year Social Security payments, or lump sum
retirement or IRA distribution). You must attach documentation that identifies the source and amount of
income and itemize how the funds were spent or invested.
‘ Unusual expenses paid.
‘ Medical, dental or nursing home expenses. You have paid excessive medical, dental, or nursing home
expenses for the 2017 calendar year that are not covered by insurance. If you itemized deductions (Schedule
A), provide a signed copy of your 2017 Federal Tax Return. If you did not itemize deductions, provide proof of
payment such as copies of canceled checks for 2017 and confirmation of total amount paid by insurance in
2017.
‘ Elementary and secondary tuition paid. You have paid for elementary, junior high, and/or high school
tuition in the 2017 calendar year for dependents in your family. Provide a letter from the school stating the
amount you have paid for tuition from January 1, 2017 through December 31, 2017.
Click on desired box
Parent Special Circumstance PSPEC
WARNING: If you purposely give false or misleading information, you may be fined, sent to prison, or both.
(v. 12/14/2018) Page 3 of 4 (S:\20_Forms\formPSPEC.wpd)
2019-2020
SUMMARY OF PARENTS’ SPECIAL CIRCUMSTANCES
Please summarize your special circumstances below:
CERTIFICATION: The person signing below certifies that all of the information reported is complete
and correct.
Parent Signature: Date:
Parent Special Circumstance PSPEC
WARNING: If you purposely give false or misleading information, you may be fined, sent to prison, or both.
(v. 12/14/2018) Page 4 of 4 (S:\20_Forms\formPSPEC.wpd)
Report all income you have actually received from January 1, 2019 through today. Then estimate all income you expect to receive from today through
December 31, 2019. YOU MUST ATTACH DOCUMENTATION OF ALL ACTUAL INCOME. Documentation could include recent pay stubs with year-
to-date earnings, W-2 forms, a letter from an employer stating your total earnings, an estimate of future income, etc. After December 31, 2019: 1)
Submit a copy of your completed 2019 Federal Tax Return, and 2) complete only the ACTUAL column below.
If you’re using the Acrobat Reader to
complete the form online, the TOTAL column along with summary totals are automatically calculated
.
TAXABLE INCOME FOR JANUARY 1, 2019 TO DECEMBER 31, 2019
ACTUAL
+
(1-1-19 to Today)
ESTIMATED =
(Today to 12-31-19)
TOTAL
(Actual + Estimated)
Expected 2019 income earned from work by Parent 1 (wages, salaries, tips)
$$$
Expected 2019 income earned from work by Parent 2 (wages, salaries, tips)
$$$
Interest income and dividends
$$$
Alimony received
$$$
Business and/or farm income
$$$
Capital gains
$$$
Pensions and Annuities (taxable amount)
$$$
IRA distributions (excluding rollovers)
$$$
Rental Income
$$$
Taxable Social Security Benefits
$$$
Unemployment compensation
$$$
TOTAL TAXED INCOME FOR 2019
$$$
UNTAXED INCOME FOR JANUARY 1, 2019 TO DECEMBER 31, 2019
ACTUAL + ESTIMATED = TOTAL
Payments to tax-deferred pension and savings plans (paid directly or withheld from
earnings) including but not limited to amounts reported on the W-2 form in boxes 12a
through 12d, codes D. E, F, G, H, and S.
$$$
IRA deductions and payments to self-employed SEP, SIMPLE, Keogh and other
qualified plans.
$$$
Child support received for all children. Don’t include foster care or adoption
payments.
$$$
Tax exempt interest income.
$$$
Untaxed portions of pensions, annuities and IRA distributions
$$$
Housing, food, and other living allowances paid to members of the military, clergy, and
others (including cash payments and cash value of benefits).
$$$
Veterans’ non-educational benefits, such as Disability, Death Pension, or Dependency
& Indemnity Compensation (DIC) and/or VA Educational Work Study Allowances.
$$$
Any other untaxed income not reported elsewhere on this form, such as workers’
compensation, disability, etc. Don’t include student aid, earned income credit,
additional child tax credit, welfare payments, untaxed Social Security benefits,
Supplemental Security Income, Workforce Investment Act educational benefits,
combat pay, benefits from flexible spending arrangements, e.g. cafeteria plans,
foreign income exclusion or credit for federal tax on special fuels.
$$$
TOTAL UNTAXED INCOME FOR 2019
$$$
Child support paid during 2019 (attach documentation of amount paid): $
Taxable earnings from Federal Work Study or other need based work programs: $
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Completed 3 January 2020

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