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SpecialCircumstancePetition1920

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Page 1 of 3
2019-2020 SPECIAL CIRCUMSTANCES PETITION
Las Positas College Financial Aid Office
Student Name:________________________________________ Student ID#:_________________________
If your financial circumstances have changed significantly since 2017, you may use this form to request the financial aid office to
consider reducing your reported income on the FAFSA or DREAM Application to better reflect your current financial situation. Your
(and/or your spouse’s if married, and/or your parents’ if a dependent) 2018 income or your expected 2019 income must be
significantly less than your 2017 income to be considered. This may result in increased financial aid eligibility.
The following situations will NOT be considered for a Reduction of Income: reduction in overtime pay, bankruptcy, retirement,
tuition paid for elementary/secondary private schooling, personal expenses (i.e. wedding, credit card bills, mortgage/loan payments,
childcare), business losses, shifts in commission sales, one-year bonus incomes (e.g. lottery/gambling winnings, pension payments,
legal awards), or stock market losses.
Complete this form, and attach a statement and required documentation to support your case. Contact the Financial Aid Office for
assistance.
PART I. REASONS FOR REVIEW OF FINANCIAL CIRCUMSTANCES: Check condition AND check the person for whom it applies.
LOSS OF EMPLOYMENT
1.___ You ___ Your Spouse ___ Your Parent(s) were employed in 2017, but now are unemployed AND have been receiving
unemployment benefits in 2019 for the past 90 days.
Required Documentation: 1) Unemployment benefit award letter and current EDD check stubs (if applicable). 2) Last paycheck stub(s) from all jobs
in 2019 for all parties. 3) Part II (page 3) Statement of expected income.
REDUCTION IN INCOME
2. ___ You ___ Your Spouse ___ Your Parent(s) has experienced a significant loss in income due to loss of a job, disability,
reduction in work hours, etc. since 2017
Please choose the year you will be reporting: 2018 2019
Required Documentation: 1)2018 Federal Tax Return if reporting reduction for 2018 year. 2) If reporting 2019 year, provide documentation of all
income received in 2019, including disability benefits (after November 15, 2019, you must submit a signed copy of 2019 Federal Tax Return and W-
2(s) for all parties instead of providing estimated income) 3) Part II (page 3) Statement of expected income if reporting 2019 expected income.
RELEASE FROM ACTIVE DUTY
3. ___You ___ Your Spouse were released from Active Duty since 2017 and your income is now significantly less
Please choose the year you will be reporting: □ 2018 □ 2019
Required Documentation: 1) DD214 2) copy of 2018 signed federal tax return if reporting 2018 income OR if reporting 2019, provide
documentation of all income received in 2019. (After November 15, 2019, you must submit a signed copy of 2019 Federal Tax Return and W-2(s) for
all parties instead of providing estimated income, if you earned income in 2019). 3) Also, if reporting 2019 income Part II (page 3) Statement of
expected income if reporting 2019 expected income.
RECEIPT OF ONE-TIME TAXABLE INCOME IN 2017
4. ___ You ___ Your Spouse ___ Your Parent(s) received a one-time income on your 2017 Federal Tax Return ( IRA rollover
into a Roth IRA, back pay from social security, etc.).
Required Documentation: Signed copy of 2017 Federal Tax Return
LOSS OF SUPPORTIVE INCOME SINCE 2017
5. ___You ___Your Spouse ___Your Parent(s) received supportive or untaxed income in 2017 (ex. alimony, child support,
social security benefits, etc.) but are no longer receiving these benefits in 2019.
Required Documentation: 1) Copy of court order, divorce agreement, or other document indicating date of termination of benefits or income.
Page 2 of 3
DEATH OF PERSON WHOSE 2017 INCOME WAS REPORTED ON YOUR FAFSA
6a. ___ Your Spouse ___ Your Parent(s) Date of Death: ________________________________
Required Documentation: 1) Death Certificate. 3) Signed copy of 2017 Federal Tax Return and W-2(s) for all parties on the tax return
NOTE: Dependent Students Only: If your last surviving parent died after filing your FAFSA, submit a Dependency Override
Petition instead of this form. You can be considered independent for financial aid purposes.
EXTRAORDINARY MEDICAL/DENTAL EXPENSES NOT COVERED BY INSURANCE
7. ___You ___Your Spouse ___Your Parent(s) has extraordinary medical or dental expenses not covered by insurance (do
NOT report if these expenses are less than 11% of your adjusted gross income), or other non-discretionary expenses such as
special needs educational expenses).
Required Documentation: 1) A summary of the expenses incurred in 2018 or 2019 that you have PAID, 2) copies of medical invoices, and proof of
payments.
YOU MARRIED AFTER SUBMITTING YOUR FAFSA*
8. ___You married after submitting your FAFSA. If it is more beneficial to stay dependent, you should not change your marital
status. Please talk to the Financial Aid Advisor or Director before completing this form.
*Change in marital status must occur before January 1, 2020
Required Documentation: 1) Statement explaining your situation 2) Marriage Certificate 3) Yours and your spouse’s signed copy of 2017 Federal
Tax Return and W-2(s) OR or 2017 IRS Verification of non-filing status (IRS form 4506).
9. ___OTHER ____________________________________________________________________________________
In a clear statement, specify other circumstances impacting your financial situation that should be considered in evaluating
your eligibility for financial aid for 2019-20, and provide appropriate documentation of those circumstances.
PART II: REQUIRED DOCUMENTATION FOR ALL STUDENTS
PLEASE ATTACH TO YOUR PETITION:
a) A typed statement explaining the circumstances and providing as much detail as possible.
b) All students should submit a signed copy of 2017 Federal Tax Return and W-2 forms (for student and spouse if married,
and parent(s) if considered ‘Dependent’ for financial aid
c) If reporting income for the 2018 year, please provide a signed tax return for the person whose income has significantly
been impacted, or other documentation of income received, as noted.
d) If reporting expected income for the 2019 year, please provide as much documentation as possible of expected income,
including any check stubs with year-to-date earnings, documentation of benefits, etc.
e) If submitting after November 15, 2019, provide a signed copy of the 2019 federal tax return (if required to file a 2019
federal tax return) plus supporting documentation of other income/resources. Otherwise submit whatever
documentation you can provide to support your calculations of expected income (for all members of the family
required to report on the fafsa).
Please contact the Financial Aid Office if you are having difficulty determining correct forms or attachments.
Page 3 of 3
PART III. PROJECTED ESTIMATED INCOME 1/01/2019 TO 12/31/2019
COMPLETE THIS SECTION ONLY IF YOU ARE REQUESTING AN ADJUSTMENT IN INCOME, BASED ON AN ESTIMATION OF ALL OF
YOUR SOURCES OF 2019 INCOME. If submitting your 2018 tax return, you do not need to complete this section. If filing this
petition after November 15, 2019, you do not need to complete this section if you will be filing a 2019 tax return. Complete this
section if you will not be required to file a 2019 federal tax return.
ESTIMATED INCOME, JANUARY – DECEMBER 2019
TYPE OF INCOME
STUDENT
SPOUSE
MOTHER/
STEP-
MOTHER
Income from work (wages)
Other taxable income
interest/pensions/annuities
Unemployment Compensation
Alimony/Spousal Support
Worker’s Comp/Disability
Child Support
Other income (specify source):
Total Projected Income for
2019:
PART III: CERTIFICATION AND SIGNATURE
Each person signing below certifies that all information reported and any attachments are
complete and correct. False statements or misrepresentations will be cause for denial,
withdrawal, and/or repayment of financial aid.
Signature of Student ________________________________________________________ Date _____________________
Signature of Parent or Student’s Spouse__________________________________________ Date _____________________
WARNING: If you purposely give
false or misleading information you
may be fined, be sentenced to jail, or
both.
For Office Use Only
___ Approved: Specific FAFSA Data fields changed: ___________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
Original EFC: _____ Recalculated EFC: ____________ Date ISIR corrected: ____________
___ Denied: Reason: _______________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________ ____________
Signature of Financial Aid Advisor or Director Date
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Completed 18 November 2019

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