3. If 2 (A) or (D) is checked, provide the applicable information on income projection for the 2020, 2021 or 2022
tax year. Darken the oval below to indicate which documents are being attached. In addition to the documents,
write a statement of explanation regarding what you are requesting and why.
Income from wages, salaries, tips (including severance pay, disability payments, and any income from work.
Provide copy of last pay stub and documentation of reason for the change such as retirement, termination, etc.
Unemployment Benefits please provide evidence of receipt of or denial of benefits.
Social Security or SSI benefits please provide evidence of termination or denial of benefits.
Workforce services benefits. Please provide evidence of expected benefits.
Child Support, please provide documentation of expected decrease in payments.
Other income, please provide documentation of any other expected income.
4.
If 2 (B) is checked, please attach verification of your income or the individual’s income that has or will provide the
majority of your support during the academic year 2021-2022, i.e. W-2 forms.
5.
If 2 (C) is checked; please provide verification of your or your surviving parent’s 2019 year income, i.e. W-2 Forms, Social
Security statements, etc.
6.
If 2 (E) is checked, please identify in an attachment, the source of 2019 income, the amount, and how funds were spent or
invested. Example: Received IRA early withdrawal of $10,000 which was counted in 2019 adjusted gross income. This is
one
time income and it was spent to pay down house mortgage. Provide documentation of severance and mortgage
payment.
III. I/my spouse or family has educational expenses in the 2021-2022 academic years that are not accurately reflected in
the determination of my Expected Family Contribution or Cost of Attendance Budget. Check the statement that applies.
A.
Medical, prescription and/or dental expenses: Please provide a statement explaining your/spouse’s / parent’s unusual
medical/dental expenses. Provide documentation to support this statement. Only out-of-pocket paid expenses will be considered. If
making
payments, provide a copy of your payment contract. Summarize all expenses on a spreadsheet.
B.
Elementary and Secondary Private School educational tuition expenses: Please provide receipts for tuition and an
explanation as to who it is for and their relationship to you.
C.
Dependent Care expenses: Please provide an attached statement indicating for whom the dependent care is provided,
their relationship to you, the days and times dependent care is required. A signed receipt or billing statement is also required
from the dependent care provided. Dependent care paid for by another agency cannot be considered.
D.
Transportation expenses exceed those allowed in the student budget: please provide a statement explaining why your
transportation budget needs to be increased. If you travel long distances each day indicate where you live and how many
times you drive this distance each week. If you must purchase airline tickets, please indicate how many times you will be
making this one way trip and document the cost by printing a price quote from the internet.
E.
Purchase of personal computer which is required for educational purposes: An invoice of the desired computer and software
must be attached. Student budgets can
only be increased once at EAC for the purpose of purchasing a personal computer.
IV. Certification:
All of the information on these forms is true and complete to the best of my knowledge. If asked, I will submit additional
proof to verify the information provided. I understand that if I do not provide this information, my request will not be
processed. I understand that submission of false information may result in a delay or denial of financial aid and may subject
me to referral to the Office of Inspector General.
Student’s signature: Date:
Parent’s signature: Date:
