Great Bay Community
College
Financial Aid Office · GBCC · 320 Corporate Drive · Portsmouth NH 03801
Request for Additional Financial Aid
Based Upon 2019 Special Circumstances
2020-2021
Your financial aid award for 2020-21 will be determined based upon 2018 income. If your 2019 income was
significantly different than your 2018 income, use this form to explain this change. You are required to document all
income from all sources for calendar years 2018 and 2019. You are also required to provide documentation of the
event or circumstances which caused the change in your income. Please call us at (603) 427-7600 ext. 7501 if you need
help with this form.
Student’s Last Name First Name Student ID
Mailing address email address Phone #
Loss
of
employment,
date
.
Whose
employment?
Divorce/Separation (date) .
Death of parent/spouse (date) .
Disability of student/parent/spouse (date) .
Loss of “one time” income (e.g. inheritance, rollover to IRA/pension account.)
Loss of child support or alimony of $ per month, beginning (date) .
Loss of other untaxed income of $ beginning (date) .
Gross Annual Income for January 1, 2019 through December 31, 2019:
Source of income
Mother
Father
Student
S
ouse
Gross wa
es/salaries/ti
s
Gross wa
es/salaries/ti
s
Other taxable income: Source: _____________
Untaxed Social Securit
/SSI
ANF
Child Su
ort
Unem
lo
ment
TOTAL GROSS ANNUAL INCOME 2019
Submit this completed worksheet with the following docu
ments:
Verification Worksheet (available on our web site
http://greatbay.edu/admissions-aid/financial-aid)
A copy of your (and your parents’ if applicable) 2018 federal tax return transcript
A copy of your (and your parents’ if applicable) 2019 federal tax return transcript
2018 and 2019 W2 forms from all employers for you (and your parents, if applicable)
Documentation of the event affecting your income (layoff notice, retirement statement, medical document, etc.)
CERTIFICATION
: A l l i n v o l v e d p a r t i e s m u s t s i g n t h i s f o r m
I certify that all information on this form is true and complete to the best of my knowledge. I agree to provide any documentation
needed to verify special circumstances.
Student Signature Date Father’s Signature Date
Spouse’s Signat
ure Date Mother
’s Signature Date
click to sign
signature
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signature
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signature
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