Submit this completed form and all supporting documents to Lamar State College Port Arthur Financial Aid Office using your preferred method.
Mail: LSCPA Office of Financial Aid ▪ PO Box 310 ▪ Port Arthur, TX 77641 Drop off: 304 Student Center
Scan and email: FinancialAid@lamarpa.edu Fax: 409-984-6021
Revised 10/21/2019
Required Documentation
Loss of employment or change in employment status
We cannot adjust for a loss of overtime or if you are self-
employed.
• Letters from prior employers, stating
termination/layoff dates on letterhead, signed,
dated and includes title/position and telephone
number.
• If you are currently employed, a copy of the last pa
y
s
tatement for 2019 from your current employer
indicating employment start date and year–to-dat
e
ear
nings.
• Copy of 2018 Tax Return Transcript, W2’s and/or
1099s
• Copy of 2019 Tax Return Transcript, W2’s and/or
1099s
• Unemployment recap showing amount of benefits
received and expected unemployment received in
2018/
2019 OR notarized statement indicating no
benefits received in 2018.*
• Documentation of any severance pay received, IRA’s,
stocks, bonds, pensions, etc. converted to cash.
*
Required for student and parent(s) if dependent–
required for student/spouse if independent.
Divorce or separation of student or parent
• Divorce – copy of divorce decree (certified)
• Separation – copy of the legal separation document;
a signed statement from your attorney, showing the
date of separation; or two notarized statements
from an unrelated third party and documentatio
n
s
howing two (2) separate households.
• Copy of 2018 Tax Return Transcript, W2’s and/or
1099s
D
eath of a spouse or parent
• A death certificate
• Copy of 2018 Tax Return Transcript, W2’s and/or
1099s
Loss of untaxed income
• A copy of a letter from the agency that provide
d
b
enefits, detailing termination of benefits, and
copies of Summaries of benefits.
D
isability of student or spouse or parent
• Medical documentation of disability and of any
benefits received as a result of the disability.*
• Copy of 2018 Tax Return Transcript, W2’s and/or
1099s
• Copy of 2019 Tax Return Transcript, W2’s and/or
1099s
*Required for student and parent(s) if dependent –
required for student/spouse if independent.
U
nusual medical or dental bills or handicapped-related
expenses
• A copy of Schedule A of the Federal Tax Transcript
or canceled checks or receipts showing amount paid
w
ith statement from insurance company showing
expenses were not reimbursed.
O
ther unusual circumstance not covered above
• Explanation and documentation
Certification and Signatures
I hereby certify that all information contained in this appeal, including the personal statement and documentation, is true and
complete to the best of my knowledge.
WARNING: If you purposely give false or misleading information, you may be fined, sent to prison, or both.
I understand that it is my responsibility to pay all outstanding balances on my account while waiting for an appeal decision. Regardless
of the appeal decision, I am responsible for any late fees incurred. My appeal will not be reviewed until all documentation has been
received. I will receive an email notifying me once it has been reviewed.
_______________________________________________________________________________________ ___________________________________________________________________________________
Student’s Signature Date Parent’s Signature (if applicable) Date
Office Use Only
Approved
Rejected Financial Aid Officer: ___________________________________________________ Date: ___________________
