Student Name _____________________________________________________ 2020-21 Request for
Student ID or Star ID ______________________________________________ Professional Judgment
Address ___________________________________________________________ Change of Income
City State Zip Code
Person Completing Form ___________________________________________
Phone _______- __________ - _____________ Email Address ___________________________________________________
I am requesting the Financial Aid Office to consider a change of income that more accurately reflects my current
financial situation due to a financial hardship.
You are required to turn in the following documents:
o A detailed letter explaining your circumstances and reasoning for this request
o The estimated income worksheet on the back of this page
o A paper copy of your tax return transcript for 2018 and all W2’s received for 2018
Please select which situation(s) below that applies to you and submit this form with all additional
requested documentation.
You have had a substantial loss or reduction of income for the current academic year due to extenuating
circumstances for a period of 8 weeks or longer.
Additional Documentation Required:
Letter or document from previous employer on company letterhead including dates of employment
and separation
If currently employed, a copy of the most recent paystub indicating year to date earnings
If unemployed, a copy of the most recent unemployment compensation statement. If you are not
receiving unemployment, please explain how you are financially supporting yourself.
_____ You have had a loss or reduction on an untaxed income or benefit which was received the past year.
Additional Documentation Required:
If applicable, letter or document from the agency/organization from which the benefit was received
indicating the last date of benefit or reduction of benefit
Loss of child supportdocumentation of child support order
_____ You have had substantial medical or dental expenses that are not covered by insurance.
Additional Documentation Required:
Copies or receipts and/or canceled checks for medical and dental payments or copy of the
IRS schedule A for the prior tax year
Please note: other reasons for a request of consideration for special circumstance may be considered. Please see
the Financial Aid Office for directions on how to complete a professional judgment request for your situation.
Financial Aid Office
3300 Century Avenue North
White Bear Lake, MN 55110
Phone: 651-779-3305
Fax: 651-779-5816
2020 Estimated Income Projections
In calculating expected income, remember you must include
the projected income for the year for the
student/spouse or parent (if dependent) from January 1, 2020 to December 31, 2020.
Wages, salary, tips and all other taxable income (do not include financial aid wages through work study
Actual Amount: Estimated Amount:
1/1/2020 to today’s date Today’s date to 12/31/2020 2020 total taxable income
Student $ _____________ + Student $ _____________ = $_________________________
Spouse $ _____________ + Spouse $ ______________ = $ _________________________
Parent(s) $ ___________ + Parent(s) $ _____________ = $ _________________________
Untaxed income (child support, payments to tax deferred pensions and savings, untaxed portions of IRA
distributions, workers compensation, other untaxed income)
Please specify type of untaxed income _____________________________________________________________
Actual Amount: Estimated Amount:
1/1/2020 to today’s date Today’s date to 12/31/2020 2020 total untaxed income
Student $ ____________ + Student $ _______________ = $ __________________________
Spouse $ _____________ + Spouse $ ________________ = $ __________________________
Parent(s) $ ___________ + Parent(s) $_______________ = $ __________________________
Household Size Information
List all members of your household in the boxes below. If you are married, include your spouse and children (if
any). If you are a dependent student, list your parents and any siblings/dependents that your parents will
support between July 1, 2020 and June 30, 2021. List the name of the college each attends, if applicable.
Full Name
Relationship to Student
College Currently
Enrolled in 6 or
more credits?
(Yes or No)
Century College
The information and projections are true to the best of my knowledge. I understand that no adjustment will be made
to the financial aid application without the appropriate supporting documentation and that the Financial Aid
Administrator may ask for additional documentation that may deviate from the items listed under each category.
Student Signature: ______________________________________________________ Date: ____________________
Parent Signature: _______________________________________________________ Date: ____________________
To be completed by Financial Aid Office Staff
_____ Approved ______ Denied ______ Updated: See comments in ISRS.
________________________________________________________________________ ________________________
Financial Aid Staff Signature Date
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