SPECIAL CIRCUMSTANCES FORM
2021-2022
Student Name: SSN/ID:
Address, City, State, Zip: Phone Number:
• Change of Income for 2021 – reverse side of form must also be completed
• The Financial Aid Oce may make adjustments to the federal financial need calculation based on a
change in income.
• Please be accurate in completing the following information.
Special circumstances can only be submitted once while attending Southeast Technical College.
Check the appropriate reason why total income will be substantially less in 2021 than in 2019:
Unemployment or change in employment (Provide documentation from employer, such as
termination notice, etc.
Divorce/Separation (Copy of divorce or separation papers)
Death of parent/spouse (Copy of death certificate)
Loss of child support (Copy of court documentation)
One-time income, such as Roth IRA, inheritance: (Need documentation of amount/source/use of funds)
Eective Date of Change:
Explain reason for along with supporting documents:
FOR CHANGE OF INCOME CONSIDERATION FOR 2021, YOU MUST ALSO COMPLETE THE BACK OF THIS FORM.
OTHER SPECIAL CIRCUMSTANCE
With appropriate reason and documentation, the Financial Aid Oce may consider adjustments to a
student’s financial aid budget or to the federal financial aid formula.
Check the appropriate reason why total income will be substantially less in 2021 than in 2020:
Unusual medical and dental expenses paid (Must submit copies of claims/bills not covered by insurance; _
copy of 2019 IRS tax return transcript and Schedule A)
Elementary and/or secondary private school tuition paid by family members (Copies of itemized receipts/
bills paid in full) Name of child(ren):
Adult care expenses (Copy of itemized receipts/bills paid in full)
Name of family member
