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

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

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Revised: 12/01/2019 SPECS
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 STUDENTS FOR 2021-2022
Student Name: ___________________________ Banner ID or NetID: ____________________________
The federal government realizes that sometimes students and 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 they were married but are now separated or divorced.
This form allows students to request a change in the student data reported on the FAFSA based upon
changes in student circumstances since the FAFSA completion date. If the student is married, spouse
changes can be requested as well. Students 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 parent
(parent income, parent marital status, etc), complete the parent version of this form in addition to any student
request: Parent 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 your financial aid programs.
STUDENT INSTRUCTIONS
1. Complete Section A if the student 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 student or spouse change in circumstance is based upon any other reason.
SECTION A: STUDENT 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. I
n order to update the FAFSA, we need to project student income (and spouse income if married) for t
he
2021 calendar year based upon the new circumstances. In the table below, report the student and spouse
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 student 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:
Student
Spouse If Married
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 SPECS
Student Name: ___________________________ Banner ID or NetID: ____________________________
3. I
n order to update the FAFSA, we also need to estimate any other student taxable income and student
non-taxable income for the 2021 calendar year (and spouse also if married). 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 student would report the total of all alimony payments received to date
this year plus 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:
Student
Spouse If Married
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Non-Taxable Income in 2021:
Student
Spouse If Married
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
4. Attach 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 student and any spouse in household.
☐ An IRS Federal Tax Return Transcript for 2019 for student and any spouse 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 student and any spouse 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
Spouse Ink Signature if Married 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 SPECS
S
tudent Name: ___________________________ Banner ID or NetID: ____________________________
SECTION B: STUDENT CHANGE IN CIRCUMSTANCE FOR ANY OTHER REASON
Complete the previous section (Section A) for a student change in marital status, reduction in income, or
reduction in benefit. Complete this section (Section B) if the student change in circumstance is based upon
any other reason.
1. Attach the following doc
umentation with your 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 the student 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.
2. Authorize and Sign:
By signing below, I certify that the information submitted with this Special Circumstance 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 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
Spouse Ink Signature if Married Date
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SPECIAL CIRCUMSTANCE REQUEST FOR STUDENTS FOR 2021-2022 The (State University of New York at Plattsburgh)

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Completed 1 February 2021

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