04.21.20 cm FSPCN1
STUDENT NAME _______________________________ ID________________ PHONE ________________
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
Summer only students – whichever date is earlier: 3 weeks before the end of your last session, or July 15, 2021
If you or your family has unusual circumstances which may affect your ability to pay educational expenses, the Boise
State Financial Aid Office will re-evaluate your financial aid eligibility. Use this form only if the income of a person
listed on your FAFSA has changed. Special Conditions are considered on a case-by-case basis and approval is
contingent upon specific circumstances.
1. Attach a letter explaining your unique circumstances. Be specific about expenses or income changes.
2. Attach a copy of your 2018 federal tax return transcript and all associated schedules (and parents’, if applicable).
3. Check the appropriate reason below and attach documents as indicated.
Divorce or separation with intent to divorce (must live at separate addresses)
o Date of divorce/separation: _____________
o Attach divorce decree or documentation of separate residences
o Number of people now in household: ______
and number in college: ______
o If it is your parents divorcing, how much financial support did you receive in 2018 from the parent whose
information is being removed from the FAFSA? $ ____________
o For all people on your FAFSA, attach all W-2/1099 forms associated with 2018 federal tax returns
Loss of social security, disability benefits, or child support
o Date benefits stopped: _____________
o Attach documentation from agency that states when benefits stop and amount received in 2020
Death of spouse or parent
o Date of death: _____________
o Attach document showing date of death
o Attach copies of all W-2/1099 forms associated with deceased’s 2018 federal tax return
o Anticipated life insurance claim amount: $ ____________
You may be asked to submit additional documents or explanations. Check your BroncoMail for follow-up questions.
Print this page to sign. Student signature is required.
Independent students: if you are married, your spouse must sign. Dependent students: one of your parents must sign.
CERTIFICATION: I certify the information provided above is true. I understand if I use false information
to establish eligibility for federal student financial aid, I could be subject to a fine, jail, or both.
Student___________________________ Date __________ Spouse_______________________ Date_____________
Parent 1___________________________ Date __________ Parent 2______________________ Date_____________