2
Loss of Income
Reduction or loss of income from work must be for at least ten (10) weeks or sufficient documentation of change and new
employment.
Parent 1 (father/mother/stepparent)
Date of layoff/termination:
Parent 2 (father/mother/stepparent)
Date of layoff/termination:
Student
Date of layoff/termination:
• Has the parent started another job? No
Yes If yes, give start date:
Yes If yes, give start date:
• Has the student started another job? No
Required Documentation:
• A letter from employer verifying loss of employment including effective date
• A copy of the last pay statement showing gross earnings year-to-date income for all jobs worked for parent(s).
If more than one employer per parent, please include start/end date in written statement.
• Documentation of unemployment benefits from state agency
• Documentation of severance pay received, or IRA’s, stocks, bonds, pensions, etc. (converted to cash).
Loss of Child Support
Name of Child: Amount received in 2020: Date support ended:
Name of Child: Amount received in 2020: Date support ended:
Required Documentation:
• A copy of legal separation/divorce decree that specifies amount of child support
• Statement from the Friend of the Court documenting amount of child support
Receipt of One-Time Income
Consideration for and one-time income may only be reviewed once during a student’s enrollment at Lake Michigan College.
Required Documentation:
• A signed copy of your 2018 U.S. Federal Tax Return and/or 1099 Form
• Written statement explaining the reason for early withdrawal
Separation or Divorce of Parents since 2018
Please note that you must be residing in separate households and provide documentation.
Date of separation/divorce:
Which parent will the stu
dent live with or which parent will provide the financial support?
Moth
er/Stepmother
Father/Stepfather
Required Documentation:
• A copy of supporting parent’s most recent pay statement; and
• A copy of the divorce decree/legal separation papers; and
• Documentation of spousal support and/or child support.
Death of a Parent since 2018
Mother/Stepmother
Father/Stepfather
Date of death:
Required Documentation:
• A copy of the death certificate; and
• Surviving parent’s 2020 income information.
Other Circumstances not addressed in the above categories
Required Documentation:
• Submit a statement that explains changes in your financial and/or family situation; and
• Supporting documentation.
