WARNING: If you purposely give false or misleading information, you may be fined, sent to prison or both.
Page 1 of 3
FA20CPJ
OFFICE OF STUDENT FINANCIAL AID
ROBESON COMMUNITY COLLEGE
Student Center Building 13
PO Box 1420
Lumberton, NC 28359
T 910.272.3352 Email: finaid@robeson.edu
F 910.272.3314 Website: https://www.robeson.edu/fa/
2020-2021 Professional
Judgment Request Form
(July 1, 2020 June 30, 2021-Tax Year: 2018)
Student’s Name: _____________________________________________ Student ID: ____________________
Address: __________________________________________ City/State/Zip____________________________
Phone #: ______________________________________ Email: ______________________________________
On a case-by-case basis, the U.S. Department of Education authorizes financial aid administrators to adjust certain data elements on a
student’s FAFSA to account for special circumstances that can better reflect their ability to pay for their education. The Financial Aid
Office will reevaluate your financial aid eligibility based on your income for either the 2019 tax year (1/1/19 to 12/31/19) or projected
income for the 2020 tax year (1/1/20 to 12/31/20). If request is received after the Fall semester has ended, please complete and
submit your taxes for the 2019 year.
SECTION I: Please select the option that best describes your special circumstances.
Loss of Job/Change of Job Status for Student/Spouse/ Parent (must be for 90 consecutive days or more)
Typed statement explaining circumstances
Termination letter/Severance letter from employer with last date of employment. If military discharge,
provide a copy of DD214.
Most recent pay stubs or statement of earnings to date
Unemployment benefits statement or statement of ineligibility for unemployment benefits.
2018 and 2019 Tax Transcript including W2s or Wage & Income Transcript
Retirement benefits (if loss of income is due to retirement)
Loss of Benefits/Other Untaxed Income (due to Child Support, Alimony, Worker’s Compensation, Disability, Social
Security Benefits, Unemployment Compensation, etc.)
Typed statement explaining circumstances
Statement from agency with last date of benefits and year-to-date amount received
2018 and 2019 Tax Transcript including W2s or Wage & Income Transcript
Death of Spouse or Parent (for dependent students)
Typed statement explaining circumstances
A copy of the death certificate
A copy of student’s Birth Certificate (if reporting death of a parent)
A copy of student’s Marriage Certificate (if reporting death of spouse)
2018 and 2019 Tax Transcript including W2s or Wage & Income Transcript
Divorce or Separation (Student or Parent)
Typed statement explaining circumstances
Divorce decree or Separation agreement (must have separate living accommodations)
2018 and 2019/or Tax Transcript including W2s or Wage & Income Transcript
Other Special Circumstances (one-time income from IRA distribution, inheritance, capital gain, etc.)
Typed statement explaining circumstances
Supporting documentation
2018 and/or 2019 Tax Transcript including W2s or Wage & Income Transcript
WARNING: If you purposely give false or misleading information, you may be fined, sent to prison or both.
Page 2 of 3
FA20CPJ
OFFICE OF STUDENT FINANCIAL AID
ROBESON COMMUNITY COLLEGE
Student Center Building 13
PO Box 1420
Lumberton, NC 28359
T 910.272.3352 Email: finaid@robeson.edu
F 910.272.3314 Website: https://www.robeson.edu/fa/
2020-2021 Professional
Judgment Request Form
(July 1, 2020 June 30, 2021-Tax Year: 2018)
SECTION II: Projected Income for 2020 Calendar Year Please provide estimates of income for the following
individual (if applicable). If an item does not apply, write “N/A”.
Please do not leave any blanks or the form will not be processed.
Income Source
Student
Spouse, if married
Parent(s), if dependent
Wages & Salaries
$
$
$
Unemployment
$
$
$
Disability benefits
$
$
$
Social Security benefits
$
$
$
Child support received
$
$
$
Alimony received
$
$
$
Other Untaxed Income
$
$
$
Other Income:
$
$
$
Total Estimated Income
$
$
$
SECTION III: Household Members - List the people in your household, including:
INDEPENDENT: You (and your spouse, if applicable); DEPENDENT: You (and your parents)
Your children (independent) OR your parent’s children (dependent), if you will provide more than half of their support
from July 1, 2020 through June 30, 2021, even if they do not live with you; and
• Other people if they now live with you and you will continue to provide more than half of their support from July 1, 2020
through June 30, 2021.
Age
Relationship
(Self, Spouse, Parent, Sibling)
College/University
Self
RCC
WARNING: If you purposely give false or misleading information, you may be fined, sent to prison or both.
Page 3 of 3
FA20CPJ
OFFICE OF STUDENT FINANCIAL AID
ROBESON COMMUNITY COLLEGE
Student Center Building 13
PO Box 1420
Lumberton, NC 28359
T 910.272.3352 Email: finaid@robeson.edu
F 910.272.3314 Website: https://www.robeson.edu/fa/
2020-2021 Professional
Judgment Request Form
(July 1, 2020 June 30, 2021-Tax Year: 2018)
SECTION IV: Student Certification
Check the box and complete section below
I hereby certify that all information reported on this form and any attachments hereto are true, complete and accurate.
False statements or misrepresentation will be cause for denial, reduction, withdrawal and/or repayment of financial aid.
Warning: According to the U.S. Department of Education, if you purposely give false or misleading information on form, you may
be subject to a fine of up to $20,000 or imprisonment for up to 5 years, or both.
______________________________________ ___________________
Student Signature Date
______________________________________ ___________________
Spouse Signature (optional) Date
_____________________________________ ___________________
Parent Signature (if dependent) Date
FINANCIAL AID OFFICE USE SECTION:
______________________________________ ___________________
Financial Aid Representative Date
Comments:
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