If you are self-employed, do contract work, or expect to receive a 1099-MISC you are unable to use this
form. Please call our office for your options
Gross Income for May 1, 2020 through April 30, 2021
STUDENT NAME_________________________________ ID__________________ PHONE__________________
If you or your family has experienced a substantial reduction in income which will negatively impact your financial resources for the
2020-2021 academic year, the Boise State Financial Aid Office can re-evaluate your financial aid eligibility. This request is for
unexpected or unplanned financial reversals, and you may be required to submit updated documentation later. Special
Conditions are considered on a case-by-case basis, and approval is contingent upon specific circumstances.
Deadlines for submitting this form:
Nov. 15, 2020 if fall 2020 is your final semester at Boise State (if you are graduating or transferring)
April 1, 2021 if you will attend spring 2021 at Boise State
1. Which individual(s) experienced a reduction in income? Check all that apply.
Student Spouse Parents
2. What caused the unexpected financial reversal? Check all that apply, and provide the documentation requested. You must be
unemployed or in your new employment for a minimum of 8 weeks before this form can be submitted.
Layoff: Attach a document from employer showing effective date and severance paid. Effective Date: .
Business Closure: Attach documentation of closure. Name of business: .
Termination: Attach a letter from employer stating effective date. Effective Date: .
Quit or reduced employment to attend school: Effective Date: . Attach document from employer
stating effective date.
Unemployment benefits ended: Effective Date: . Attach unemployment office document showing end date.
New employment with lower wages: Effective Date: .
Other: Please specify and attach documentation. __________________________________________________________
3. Attach the following documents: (Provide detailed information and documentation of your circumstances to reduce processing time.)
Write a detailed letter and provide documentation explaining the unique circumstances that are impacting your 2020-2021
family income and your ineligibility for unemployment income, if applicable.
Attach documentation of eligibility for unemployment benefits and amount of unemployment benefits, if applicable.
Complete the Assets Charts on pages 2 of this form.
Attach recent pay stubs showing YTD info for each job listed on page 2 for all individuals listed on the 2020-2021 FAFSA.
You may be asked to submit additional documents or explanations of your circumstances. Please check your BroncoMail for
any follow-up questions.
CERTIFICATION: I certify that the information provided is true and is my income projection. If a new job is
found, or my family’s income situation improves, I will notify the Financial Aid Office immediately. I understand if
I use false information to establish eligibility for federal student financial aid, I could be subject to a fine, jail, or
Student__________________________ Date_________ Spouse__________________________ Date____________
Parent 1__________________________ Date _________ Parent 2_________________________ Date____________
Dependent students: You and one of your FAFSA parent must sign this form
Independent students: You and your spouse (if you are married) must sign this form
Financial Aid and Scholarships
Administration Building Room 113
1910 University Drive
Boise, ID 83725-1315
Phone: (208) 426-1664
Fax: (208) 426-1305
06.30.20 cm Page 2 of 2 FISPC1
Mark “0” or amount in EVERY BOX. Report in each column for all individuals listed on the 2020-2021 FAFSA.
Description of income/asset:
Interest or dividend earnings.
Cash support or any money paid on your behalf, including
support from a non-custodial parent or any other person.
+Child support received for children not reported in
household on FAFSA
- Child support paid
Veterans non-educational benefits (i.e., death pension,
dependency & indemnity compensation, disability, work-
study, etc.
Withdrawals from tax-deferred pension, savings, IRAs,
401(k), 403(b) plans or life insurance disbursements.
Housing, food, and other living allowances paid to
members of the military, clergy, and others (including cash
payments and cash value of benefits).
Other untaxed income (i.e., AFDC, ADC, other Welfare
Benefits, Refugee Assistance, JTPA non-education
benefits, disability income). Specify what it is.
Assets: As of today, what is the net worth of investments,
including real estate (not including the home you live in)?
Assets: As of today, what is the net worth of current
businesses with 100 or more employees and/or
investment farms? Do not include a farm that you live on
and operate.
Assets: As of today, what is your total balance of cash,
savings, and checking accounts? Do not include
student financial aid.
Exemptions: What amount of the gross earnings reported
on this form is from federal or state work/study income
(do not include veteran’s work-study here; add it above)?
Provide all work locations you, your spouse, and/or parent(s) have worked since May 2020 and will work until April