QUINCY COLLEGE
Quincy'College'Financial'Aid'Office'1250'Hancock'St,'Quincy,'MA'02169''(p)'617-984-1620''(f)'617-984-1769'quincycollege.edu'
Petition'for'Reconsideration'Due'to'Special'Conditions'2020-21'
'
Student’s'Name_____________________________________''''Quincy'College'ID#____ _ _ _ _ _ _ __ _ _ _ _ _ _ _ __ _'
Student’s'SSN:'_______-____-________'
Instructions'
Our'goal'is'to'accurately'review'your'ability'to'contribute'towards'your'educational'costs'and'provide'the'most'
appropriate'financial'aid'package'based'upon'the'information'provided'to'our'office.'Please'be'aware'that'all'financial'
aid'awards'are'need-based.'
You'may'request'a'review'of'your'financial'aid'package'at'any'time'due'to'a'change'in'you'or'your'family’s'
circumstances'or'in'light'of'new'information'regarding'unusual'situations'that'you'or'your'family'may'be'facing.'
Inform a tio n 'p re s ented'in'th is 'ap p e a l'sh ould'be'e ith e r 'n ew'inform a tio n 'or'inform a tio n 't h a t'h a s'c h a n ge d 's ign if ica n tly '
from'your'initial'ap p licatio n.'Plea se 'complete'all'sections 'of'this'fo rm 'as'co mpletely'and'accurately'as'possible.'Please'
submit'2019'signed'fede ral'tax'returns'and'2018'signe d'federal'tax'returns'and'W-2s'(if'not'previously 're ce ive d'with'
your'financial'aid'application).'Federal'taxes'are'required'for'all'appeal'processing'in'order'to'make'sure'that'your'
application'is'based'on'accurate'numbers.''
Reason'for'Appeal'
Check'the'item'below'that'most'accurately'describes'your'situation.'You'may'check'more'than'one'if'appropriate.'Be'
sure'to'complete'the'back'of'this'form'as'accurately'as'possible'in'all'cases.''
__'Student'or'parent'is'currently'unemployed.'Date'employment'ended:'___________.'Attach'documentation'of'official'
letter'of'se p a rat io n ,'se ve ra n ce 'p ac ka g e ,'an d /o r'u n e mploym en t 'be n e fits 'as 'w e ll'a s'most'rece n t'p a y's tu b s'f or 'yo u 'o r'e ac h '
parent'(if'a'parent'has'become'unemployed).''
__'Untaxed'income'or'benefits'received'have'ended.'Date'of'termination:___________.'Attach'documentation'from'the'
agency'providing'the'benefits.''
__Extraordinary'unreimbursed'medical'and/or'dental'expenses.'Amount'for'2018'calendar'year:__________.'Attach'a'
detailed'letter'and'supporting'documentation'of'the'expenses.''
__One-time'cap ital'gain'o r'distribu tion.'Ple ase 'attach 'a'letter'e xplain ing'th e'circu m stan ces 'that'res ulted 'in'the 'capital'
gain/distribution.'Please'note'that'both'the'circumstances'and'the'capital'gain/distribution'are'one-time'occurrences,'
which'did'not'occur'in'2018'and'are'not'expected'to'occur'again'in'2019'or'2020.''
__Death'of'a'parent.'Date:___________.'Attach'documentation'of'any'death'benefits'received.''
__'Other.'If'none'of'the'above'categories'describes'your'or'your'family’s'situation,'attach'an'explanation'of'your'
circumstances'with'as'much'detail'and'documentatio n 'a s'p o ss ib le .'If'yo u r's itu a tio n 'in vo lv es 'a'c h a ng e 'in 'in co me,'
complete'the'Projected'Income'Section'on'the'next'page'of'this'form.''
It#is#the#stu d e n t’s#r es p o n sib ility #to #n o tif y#o u r#o f fice #if#a n y #o f#th e #a bo v e #in fo rmation#sh o u ld #ch a n g e .#T h is#n o tif ica tio n #should#
occur#within#two#weeks#of#any#change.##
Once'we'review'your'appeal'and'determine'if'an'adjustment'can'be'made'to'your'financial'aid'package,'we'will'notify'
you'of'the'outcome'in'writing.'Response'time'will'vary'based'on'the'volume'of'appeals'at'the'time'your'request'was'
received.'
Projected'2020'Income'
Only'complete'this'section'if'you'are'appealing'based'on'a'loss'of'employment'or'any'other'income-related'chang e.''
Be'certain'to'complete'all'of'the'income'sections,'not'just'the'category'that'has'changed.''
Attach'any'documentation'you'have'for'your'figures,'such'as'most'recent'pay'stubs,'a'letter'from'your'employer'regarding'
severance'package'terms,'unemploym ent'benefit'statemen t,'etc.'
Enter'0'if'no'income'of'a'certain'type'is'expected.''
Estimated'2020'Taxable'Income'(1/1/20-12/31/20)' ' Estimated'2020'Income'
1. Student’s'2020'work'income' ' ' ' $__________________' '
2. Spouse’s'2020'work'income' ' ' ' $__________________' ' ' '
3. Father’s/stepfather’s'2020'work'income'' ' $__________________'
4. Mother’s/stepmother’s'2020'work'income' ' $__________________'
5. Severance'compensation' ' ' ' $__________________'
6. Unemployment'compensation' ' ' ' $__________________'
7. Interest'a n d 'd iv id e n d 'in come'' ' ' ' $__________________'
8. Business'or'real'estate'income/loss' ' ' $__________________'
9. Taxable'IRA/pension/annuity'distribution' ' $__________________'
10. Other'taxable'income' ' ' ' ' $__________________'
(such'as'tax'refun d s,'alim on y,'cap ital'ga in, ' ' '
Taxable'social'security,'etc.)'
'
Total'income'from'numbers'1'through'9'above'' $__________________'
Estimated'2020'Untaxed'Income'(1/1/20-'12/31/20)'
Untaxed'Social'Security'Benefits'''' '$____________' Earned'Income'Credit' $____________'
Child'support'received'for'all'children'' '$____________' AFDC/ADC'or'TANF' $____________'
Untaxed'pension'distributions''''' $_____________' Cash/gifts'paid'on'your' $____________'
Payments'to'IRA/401k/other'plans' $_____________' behalf'
Tax'exempt'interest'income' ' $_____________' Worker’s'Comp.' $____________'
Education'tax'credits'' ' ' $_____________' Other'untaxed'income'' $____________'
' ' ' ' ' ' ' ' (please'specify)____________________'
Certification'Statement'
The'information'on'this'form'is'accurate'and'complete'to'the'best'of'our'knowledge.'We'have'provided'our'signed'2018'and'2019'federal'tax'
returns,'including'all'schedu les'an d 'W-2'statements.'We'understand'that'completing'this'form'does'no t'gu aran tee 'finan cial'aid'w ill'increa se.'W e '
also'agree'to'notify'the'Office'of'Financial'Aid'if'our'income'changes.''
Student’s'Signature_____________________________________________________''''''''Date'___________________'
Parent'signature'(if'applicable)_____________________________________________''Date__________________'
OFFICE'U SE'ONLY'''''''''''''''''''''''''''''''''''''''''Data'elem ents'to'be'adjusted:'
AGI&'taxes'paid_________' Income'from'work _ _ ____ _ ___' Unt axed 'Incom e____ _____ _'
Income'exclusion'________' ' ' Approved____' Denied____ ''Director______ __ _____ Date_ _____ '
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