The FAFSA information received by the Student Financial Services Office indicated that you, your spouse, or a parent was a
“dislocated worker.” The federal definition of a “dislocated worker” lists four types of people who are dislocated workers:
1. A person who is receiving unemployment benefits due to lay off or losing a job and is unlikely to return to
a previous occupation.
2. A person who has received a lay-off notice from a job.
3. A self-employed person who has lost income and is under-employed due to the economy.
4. A person who is a displaced homemaker one who provided unpaid services in the home and is no longer
supported by the husband or wife.
Note: A person who has quit a job may not be considered a dislocated worker.
Please indicate the name of the person(s) for whom you have indicated “Dislocated Worker” status.
Student Name: MTC ID:
(Check One)
Dislocated Worker #1: Student Spouse Parent
Dislocated Worker #2: Student Spouse Parent
Dislocated Worker #3: Student Spouse Parent
If the 2018 tax information submitted on the FAFSA does not accurately describe the income(s) available for the
2019 or 2020 calendar year, you may submit actual current year income documentation (2019) to see if you are eligible for
an income adjustment made to the FAFSA.
Bring your most recent paycheck stubs or your earnings summary from your unemployment office. Your current or
anticipated unemployment benefit summary will also be needed. Documentation for each dislocated worker should be
attached to this form and submitted to the Student Financial Services Office for reprocessing of the FAFSA. By
submitting this information and signing this request, you are requesting a Professional Judgment Review.
Signature of Student Signature of Dislocated Worker Date
Contact your local Job Center or Unemployment Center to determine if additional federal or state grants may be available through
the Workforce Investment Act to help get training and/or educational assistance. These grants are intended to help dislocated
workers get back into some type of regular employment. Assistance may be available for parents as well as our current students.
MIDLANDSTECH.EDU i PO Box 2408 i Columbia, SC 29202 i 803.738.7792
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