Fillable SPECIAL CIRCUMSTANCE REQUEST FOR PARENTS FOR 2021-2022 The (State University of New York at Plattsburgh)

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SPECIAL CIRCUMSTANCE REQUEST FOR PARENTS FOR 2021-2022 The (State University of New York at Plattsburgh)

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Revised: 12/01/2019 SPECP
Financial Aid Office • SUNY Plattsburgh • 101 Broad Street • Plattsburgh, NY 12901-2681
Tel: (518) 564-2072 • Toll-Free: (877) 768-5976 • Fax: (518) 564-4079 • email: finaid@plattsburgh.edu
SPECIAL CIRCUMSTANCE REQUEST FOR PARENTS FOR 2021-2022
Student Name: ___________________________ Banner ID or NetID: ____________________________
The federal government realizes that sometimes families experience changes in circumstance since the
completion of the FAFSA. This can include, but is not limited to, a change in marital status, reduction or loss of
income, and reduction or loss of benefit. For example, the student may have correctly reported on the FAFSA
that the family earned $50,000 in adjusted gross income (AGI). However, since then there has been parental
job change and the family AGI is now $30,000 instead of $50,000.
This form allows parents to request a change in the parent data reported on the FAFSA based upon changes
in parent circumstances since the FAFSA completion date. Parents can only request changes that remain in
effect during the 2021 calendar year: between January 1, 2021 through December 31, 2021. If the changes
are related to the student (student income, student marital status, etc), complete the student version of this
form in addition to any parent request: Student Special Circumstance Consideration for 2021-2022.
If this Special Circumstance is approved, the Financial Aid Office will update the FAFSA with the new data.
Depending upon the magnitude of the change, this may or may not impact financial aid programs.
PARENT INSTRUCTIONS
1. Complete Section A if the parent change in circumstance is based upon one of the following:
• Change in marital status since the FAFSA completion date (widowed, divorced, or separated)
• Reduction or loss of income since the FAFSA completion date (ex. retirement, unemployment, j
ob
c
hange, bankruptcy, illness, death in family, etc.)
• Reduction or loss of benefit since the FAFSA completion date (ex. benefit loss or reduction due t
o
child support, social security, unemployment, alimony, retirement, disability, TANF, etc.)
2. Complete Section B if the parent change in circumstance is based upon any other reason.
SECTION A: PARENT CHANGE IN MARTIAL STATUS, INCOME, OR BENEFIT
1. Check the reason for the request and report the date of the change:
Reason Date of Change
☐ Change in marital status
☐ Reduction or loss of income
☐ Reduction or loss of benefit
2. In order to update the FAFSA, we need to project parent income for the 2021 calendar year based upon the
new circumstances. In the table below, report the parent wages earned from work before today and the
expected or estimated wages for the remainder of the year. For example, if a job change has occurred,
report parent wages earned as of today and then estimate any unemployment compensation or additional
wages that are expected to be earned until December 31, 2021.
Leave no spaces blank, enter zeros when appropriate.
Wages From Work In 2021:
Parent1
Parent2
Wages earned from: January 1, 2021 to Today
$
$
Wages expected or estimated from: Today to December 31, 2021
$
$
Financial Aid Office • SUNY Plattsburgh • 101 Broad Street • Plattsburgh, NY 12901-2681
Tel: (518) 564-2072 • Toll-Free: (877) 768-5976 • Fax: (518) 564-4079 • email: finaid@plattsburgh.edu
Revised: 12/01/2019 SPECP
Student Name: ___________________________ Banner ID or NetID: ____________________________
3. I
n order to update the FAFSA, we also need to estimate any other parent taxable income and parent non-
taxable income for the 2021 calendar y
ear. In the tables below, report the amounts for each item for the
entire 2021 calendar year: January 1, 2021 to December 31, 2021. This includes any actual amounts
received so far this year plus any estimated amounts for the remainder of the calendar year. For example,
the parent would report the total of all alimony payments received to date this year plus the estimated
alimony payments that are expected to be received for the remainder of the year.
Leave no spaces blank, enter zeros when appropriate.
Other Taxable Income in 2021:
Parent1
Parent2
Alimony
$
Business or Farm Income
$
IRA Distributions
$
Pensions and Annuities
$
Unemployment Compensation
$
Taxable Social Security Benefits
$
Other (Rentals, royalties, etc.)
$
Non-Taxable Income in 2021:
Parent1
Parent2
Welfare benefits, including TANF (exclude food stamps)
$
Tax deferred pension and savings payments
$
Child support received for all children
$
Untaxed portions of IRA distributions (exclude rollovers)
$
Untaxed portions of pensions (exclude rollovers)
$
Living allowances for clergy, military and others
$
Veterans non-education benefits
$
Other untaxed income (workers comp., disability, etc.)
$
Money received or paid on your behalf (bills, gifts, etc.)
$
4. Attac
h the following documentation with your request:
☐ Detailed letter of explanation including relevant dates (date of change in marital status, loss of job,
etc.), and source of any loss of income or benefit. Includes copies of any death certificate.
☐ Copies of last 2021 pay stub(s) as of today for each job held for all parents in household.
☐ An IRS Federal Tax Return Transcript for 2019 for all parents in the household or signed copies of
2019 Federal Tax Returns. Tax Return Transcripts can be ordered at www.irs.gov or by calling 1-800-
908-9946.
☐ 2019 W-2 statements for all parents in household.
5. Authorize and Sign:
The information provided on this form is true and complete to the best of my knowledge. I agree to notify
the Financial Aid Office at SUNY Plattsburgh of any error, omission, or of any further circumstances that
may affect the accuracy of the above provided information. I understand that failure to comply with this
agreement could result in the forfeiture of financial aid eligibility for the student
Student Ink Signature Date
Parent Ink Signature Date
Financial Aid Office • SUNY Plattsburgh • 101 Broad Street • Plattsburgh, NY 12901-2681
Tel: (518) 564-2072 • Toll-Free: (877) 768-5976 • Fax: (518) 564-4079 • email: finaid@plattsburgh.edu
Revised: 12/01/2019 SPECP
S
tudent Name: ___________________________ Banner ID or NetID: ____________________________
SECTION B: PARENT CHANGE IN CIRCUMSTANCE FOR ANY OTHER REASON
Complete the previous section (Section A) for a parent change in marital status, reduction in income, or
reduction in benefit. Complete this section (Section B) if the parent change in circumstance is based upon any
other reason.
1. Attach the following documentation with y
our request:
☐ A detailed letter of explanation of the situation and appropriate supporting documentation. The
Financial Aid Office may requests additional documentation after reviewing this request.
☐ Copies of paid receipts or cancelled checks showing expenses incurred (not bills).
☐ An IRS Federal Tax Return Transcript for 2019 for all parents in the household or signed copies of
2019 Federal Tax Returns. Tax Return Transcripts can be ordered at www.irs.gov or by calling 1-800-
908-9946.
☐ 2019 W-2 statements for all parents in household.
2. Authorize and Sign:
By signing below, I certify that the information submitted with this Special Circumstance is true and
c
omplete to the best of my knowledge. I agree to notify the Financial Aid Office at SUNY Plattsburgh of
any error, omission, or of any further circumstances that may affect the accuracy provided information. I
understand that failure to comply with this
agreement could result in the forfeiture of financial aid eligibility
for the student.
Student Ink Signature Date
Parent Ink Signature Date
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SPECIAL CIRCUMSTANCE REQUEST FOR PARENTS FOR 2021-2022 The (State University of New York at Plattsburgh)

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Completed 1 February 2021

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