Fillable Independent Income Change Appeal (Eastern Wyoming College)

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Independent Income Change Appeal (Eastern Wyoming College)

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Financial Aid Office
3200 West C Street
Torrington, WY 82240
p: 307.532.8224
f: 307.532.8222
financialaid@ewc.wy.edu
2019-2020
Income Change/Special
Circumstance Appeal
(Independent student)
PLEASE NOTE: You must have filed a 2019-2020 Free Application for Federal Student Aid (FAFSA) and have completed your
financial aid file (received an award letter) BEFORE submitting this form. All appeals must contain supporting documentation.
Unsigned, incomplete or inadequately documented forms will not be considered. Submission of an appeal does not imply your
request will be approved. Appeals should be submitted as soon as possible, but no later than mid-term of the semester for which
the student is requesting aid.
Financial aid eligibility is normally based on the student’s and his/her spouse’s (if applicable) gross annual income for
the FAFSA tax year. The Federal Methodology formula uses information from the FAFSA to estimate what you might
be able to pay toward your educational expenses. The formula automatically adjusts for certain expenses, but students
sometimes have a decrease in income or other financial issues in a subsequent year that would not be reflected on the
FAFSA. If this year’s FAFSA does not reflect your current financial situation, we may be able to re-evaluate your
financial need based on your 2018 information and/or projected gross income for 2019. For independent students, we
consider income for the student and, if married, the spouse.
You will be notified in writing of the Appeal Committee’s decision. Allow 30 days for review. Additional time may be
needed for review if the Financial Aid Office requests additional information. If we are able to make adjustments, we will
submit corrections to your FAFSA data. If you qualify for additional aid based on your adjusted financial need, we will
award the additional aid when the correction process is complete. This correction process could take up to two more
weeks, depending on the time of year.
WHAT IS A “SPECIAL CIRCUMSTANCE”?
Special circumstances are usually defined as unexpected events or situations beyond your control. Examples include (but
are not limited to): loss of employment, reduction in hours, loss of benefits such as Social Security or child support,
disability, separation or divorce after filing the FAFSA, death of a spouse after filing the FAFSA.
WHAT IS NOT ELIGIBLE FOR APPEAL? (not limited to these examples)
• Routine personal living expenses (car payments, insurance, credit card bills, mortgage/rent)
• Unusual personal living expenses (wedding costs, legal expenses)
• Reduction in overtime pay
• Bankruptcy
• One-time income from gambling earnings
INSTRUCTIONS
 Complete this form only if your family’s gross income has decreased at least 20% from what it was the
previous year(s).
In addition to completing this form and providing all situation-specific supporting documentation, all appeals must include the
following documentation:
A typed (or neatly hand-written), signed statement explaining your family’s special circumstances
Signed copy of your 2017 and 2018 Federal Income Tax Return (or Tax Transcript) and W-2 forms
Signed copy of your spouse’s (if applicable) 2017 and 2018 Federal Income Tax Return (or Tax Transcript) and W-2 forms
A copy of the most recent pay stub from each employer
Verification of all untaxed income received in 2017 and 2018
Complete the Estimated Income/Expenses Worksheet on page 4
Appeals submitted after 12/31/19 MUST include signed copies of 2019 Federal Income Tax Returns and all W-2s
*Please note that omitting required documentation may cause delays in your appeal’s review or your appeal may be denied.
REQUIRED DOCUMENTATION
___________________________________________________________ ____________________ __________________________
Last Name First Name M.I. EWC Student ID Number Social Security Number (last four digits)
___________________________________________________________ _______________________________________________
Mailing Address (include apartment number) E-mail Address
___________________________________________________________ _______________________________________________
City, ST, Zip Phone Number (include area code)
A. Unemployment or reduction of hours or wages
Student or spouse who worked in 2017 is now unemployed or has had work hours and/or wage rate reduced.
Required documentation:
Copy of last pay stub(s) from previous employer(s)
Copy of letter from employer on letterhead verifying the release from employment or reduction in hours/wages, the date the
change became effective and the duration of the reduction if temporary
Notice of eligibility or denial for unemployment benefits
Copy of disability benefit statement if applicable
B. Medical or dental expenses
You or your spouse made payments for expenses not covered by insurance. Medical expenses for which you received no
insurance or other reimbursement must exceed 11% of the family’s taxable income in order to be considered.
Required documentation:
Submit copies of receipts or billing statements showing amounts for which you received no insurance or other reimbursement, as
well as documentation of payment
Total medical expenses for which you received no insurance or other reimbursement(s): $__________________.
C. Retirement
Student or spouse who worked in 2017 has retired.
Required documentation:
Copy of last pay stub(s) from previous employer(s)
Copy of retirement benefit statement
Letter from previous employer on letterhead stating last date of employment
D. Death of spouse
Spouse passed away after the FAFSA was filed.
Required documentation:
Copy of death certificate, obituary, or funeral program
E. Separation or divorce
Student was married when the FAFSA was filed, but has now separated or divorced.
Required documentation:
Court documentation verifying legal separation or divorce, or letter from attorney documenting that legal proceedings have begun
F. Reduction or loss of support or benefits
Student or spouse received support or benefits in 2017 that have been terminated or reduced. Support or benefits may
include: worker’s compensation, unemployment benefits, child support, Social Security benefits, pensions, etc.
Required documentation:
Last check stub or printout of benefit received
Letter from agency on letterhead verifying the date and amount of benefit lost
G. One-time income
Student or spouse received non-recurring income in 2017 from a pension, IRA, annuity, inheritance, settlement, etc.
Required documentation:
Copy of form 1099 or other statement from paying agency showing the one-time income
Explain why the one-time income is not available for education expenses; include documentation
.
A: STUDENT INFORMATION
B: REASON FOR SUBMITTING APPEAL (check all that apply)
H. Dislocated Worker/Displaced Homemaker
Student/spouse is a Dislocated Worker if he/she is receiving unemployment benefits due to being laid off or losing a job
and is unlikely to return to a previous occupation or was self-employed but is now unemployed due to economic
conditions or natural disaster. A Displaced Homemaker is generally a person who previously provided unpaid services to
the family (e.g. stay-at-home parent), is no longer supported by the spouse, is unemployed or underemployed, and is
having trouble finding or upgrading employment.
Required documentation:
Copy of letter from employer on letterhead verifying the release from employment or reduction in hours/wages, the date the
change became effective and the duration of the reduction if temporary
Notice of eligibility or denial for unemployment benefits
I. Other
You or your spouse has other unusual circumstances not listed above.
Required documentation:
Explain the circumstances in detail, including the impact on your ability to pay for your educational expenses
Attach supporting documentation of the circumstances
For the following questions, ONLY include information for the student and spouse (if applicable), whose income was included on
the 2019-2020 Free Application for Federal Student Aid (FAFSA).
Whose income decreased? _______________________________________________________________________________
What date did the change in circumstance occur? ______/______/__________
*Explain below (or attach a typed, signed personal statement explaining), in as much detail as possible, why you are requesting
a change in income. Please list dates that the changes occurred and how it impacted your income. You must provide
appropriate documentation. Be as detailed as possible about the change in your circumstances.
____________________________________________________________________________________________________________
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C: EXPLANATION OF SPECIAL CIRCUMSTANCES
The following section requires you to provide your (and your spouse’s, if applicable) expected income for 2019. Please provide figures
for the entire year; do not report hourly or monthly wages or income. Include all income received from January 1, 2019 until now, and
estimate amounts to be received from now until December 31, 2019. This form may be completed in pencil.
Do not leave any line blank. List the yearly amount you expect to pay in expenses and receive from income in 2019.
If no income/expenses are expected, you MUST write “$0” or “N/A”.
EXPENSES FOR 2019 JAN. 2019—TODAY TODAY—DEC. 2019 TOTAL
Rent/mortgage $__________________ $__________________ $_______________
Utilities $__________________ $__________________ $_______________
Insurance: Home/apartment $__________________ $__________________ $_______________
Auto $__________________ $__________________ $_______________
No line
Tuition/fees $__________________ $__________________ $_______________
may be
Books/supplies $__________________ $__________________ $_______________ left blank!
Food $__________________ $__________________ $_______________ If $0, please
Clothing $__________________ $__________________ $_______________ provide an
Transportation (gas, repairs) $__________________ $__________________ $_______________ explanation
Car payments/lease $__________________ $__________________ $_______________
on a separate
Unreimbursed medical/dental $__________________ $__________________ $_______________ form.
Recreation $__________________ $__________________ $_______________
Other (specify): ____________ $__________________ $__________________ $_______________
____________ $__________________ $__________________ $_______________
TOTAL EXPENSES: $__________________ $__________________ $_______________
INCOME FOR 2019 JAN. 2019—TODAY TODAY—DEC. 2019 TOTAL
Student’s gross income from work $__________________ $__________________ $_______________
Spouse’s gross income from work $__________________ $__________________ $_______________
Interest/dividend income $__________________ $__________________ $_______________
Pensions/annuities $__________________ $__________________ $_______________
If your total
Unemployment compensation $__________________ $__________________ $_______________ expenses
Severance pay $__________________ $__________________ $_______________
exceed your
Alimony/spousal support $__________________ $__________________ $_______________ total income,
Social Security benefits $__________________ $__________________ $_______________ you must
Veterans benefits $__________________ $__________________ $_______________
provide a
Child support received $__________________ $__________________ $_______________
detailed
AFDC/TANF/SNAP $__________________ $__________________ $_______________
explanation
Resources from parents/relatives $__________________ $__________________ $_______________ of how you
Financial aid $__________________ $__________________ $_______________ plan to meet
Other (specify): ____________ $__________________ $__________________ $_______________ expenses.
TOTAL INCOME: $__________________ $__________________ $_______________
By signing this worksheet, I/we certify that all of the information reported is complete and correct. I/we also acknowledge that I/we
have read and agree to comply with all verification policies as stated by EWC in the College Catalog and on the EWC website. Failure
to submit information in a timely fashion may result in the application being filed as inactive with no further consideration and no
federal aid for the academic year. Student and spouse (if applicable) must sign:
Student’s signature: ________________________________________________ Date: ___________________________
Spouse’s signature: _________________________________________________ Date: ___________________________
Printed names: ______________________________________________________________________________________
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, sentenced to jail, or both.
Revised 11/2018
D: ESTIMATED INCOME/EXPENSES WORKSHEET
E: CERTIFICATION AND SIGNATURE
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Independent Income Change Appeal (Eastern Wyoming College)

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Completed 23 July 2020

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