Fillable Summer 2021 Income Reduction Form 11400 Robinwood Drive (Hagerstown Community College)

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Summer 2021 Income Reduction Form 11400 Robinwood Drive (Hagerstown Community College)

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WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.
Do not submit this form unless you have already filed a 2020-2021 Free Application for Federal
Student Aid (FAFSA) and received a copy of your results. Financial need is usually based on
annual income from prior-prior tax year data (2018). If your income has recently decreased or you
have special financial issues that were not taken into account on your FAFSA, we may be able to
reevaluate your financial and/or income information using the 2019 tax year or another 12 month time
period that better reflects your financial circumstances.
A professional judgment (PJ) adjustment may be warranted if a family member experienced a
significant change of income, either upward or downward. For example: for an individual who has lost
a job or has taken a significant salary cut beginning in December of 2018, the Student Financial Aid
Administrator (SFAA) may use the income for the 12-month period following the reduction in income
(January 2019 through December 2019) instead of the prior-prior year income (calendar 2018) that
was initially used in the EFC calculation. Alternatively, the SFAA may choose to use more recent
income that more accurately reflects the family's current financial circumstances.
A SFAA may use PJ on a case-by-case basis only to adjust the student’s cost of attendance or the
data used to calculate a student’s EFC. This adjustment is valid only at the school making it. The
reason for the adjustment must be documented (by a third party if possible), and it must relate to the
special circumstances that differentiate the student from other students—not to conditions that exist
for a whole class of students. The law gives some examples of special circumstances, such as
elementary or secondary school tuition, medical or dental or nursing home expenses not covered by
insurance, unusually high child care costs, being homeless or a dislocated worker, recent
unemployment of a family member, or other changes in the family’s income or assets.
We cannot make adjustments for any of the following circumstances:
• Vacation expenses
• Tithing expenses
• Standard living expenses like utilities, mortgage or rent
• Credit card expenses
• Children’s allowances
• Post-enrollment activity expenses
Please DO NOT MAKE CHANGES TO YOUR SAR / FAFSA. Once we have reviewed your
request we will make all the appropriate corrections.
Student Financial Aid Office
11400 Robinwood Drive
Hagerstown, MD 21742
finaid@hagerstowncc.edu
FAX: 301-791-9165
Fall 2020 –
Summer 2021
Income Reduction
Form
Student Financial Aid Office
11400 Robinwood Drive
Hagerstown, MD 21742
Phone: 240-500-2473
finaid@hagerstowncc.edu
FAX: 301-791-9165
Required Documents: Please read carefully. Check off all included information requested
below.
ALL APPEALS MUST INCLUDE:
Proof of qualifying event: Examples include: unemployment benefits statement, retirement or termination
notice, memo/letter from employer regarding change or reduction in employment, physician’s disability
statement, lawyer’s statement regarding separations, court statements regarding divorce, termination of
child support, social security benefit termination notice, death certificate, or obituary notice.
Completed 2020-2021 Income Reduction Form.
Typed explanation of the income-lowering event, including exact dates of the event.
Completed 2020-2021 Verification Worksheet. Please complete and print this separate form from our
Forms Page
.
Copy of the student and spouse’s (if applicable) 2018 OFFICIAL Federal IRS Tax Return Transcript.
This can be ordered from https://irs.gov.
Copy of the parent’s (for dependent students – not required for independent students) 2018 OFFICIAL
Federal IRS Tax Return Transcript. This can be ordered from https://irs.gov.
Completed 2020-2021 Asset Worksheet. Please complete and print this separate form from our Forms
page.
Copy of all the student’s and spouse’s (if applicable) 2018 W2’s.
Copy of all the parents’ (if applicable) 2018 W2’s.
A signed copy of the student and spouse (if applicable) 2019 tax forms (1040, 1040A, or 1040EZ) and all
W2’s.
A signed copy of parents ((for dependent students – not required for independent students) 2019 tax
forms (1040, 1040A, or 1040EZ) and all W2’s.
Final income statements (paycheck stubs) from all 2020 employers (if no longer employed)
Two current pay stubs or earnings statements from all current 2020 employers, for student, spouse,
and/or parents as applicable.
Two current statements from all non-W-2 related 2020 income (i.e. taxable Social Security, Worker’s
Compensation, Unemployment Compensation, projected business or rental income, etc.), for student,
spouse, and/or parents as applicable
.
RETURNED TO THE STUDENT IF SUPPORTING DOCUMENTS
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.
Name: ____________________________________________________________
HCC ID#:________________________ Phone #: ____________________
E-mail: ________________________
Why is your current income less than your 2018 income?
Parent Student/Spouse
Unemployment, reduced employment, or job change
Disability or natural disaster
Separation or divorce after filing FAFSA
Death of spouse or parent after filing FAFSA
Loss of untaxed income or benefits (social security, child support, etc.)
Received one time non-recurring income (IRA withdrawal, inheritance, etc.)
Other ________________________________________
Are you currently employed? NO YES - Current employer: ___________________
Explanation of Income Reduction
Please provide a typed explanation detailing your situation. Be sure to include all relevant
information, i.e. dates the qualifying event occurred, the individuals it affected, and any other
information you feel would justify this request for an income reduction. Be complete in your
written explanation as it determines the outcome of your request. Your Income Reduction Appeal
will not be complete without the typed explanation.
Only those responsible for the submitted income information should sign below.
I understand that no changes will be made until I provide all the information requested.
________________________________________ ________________________________________
Student Signature Parent Signature (if applicable)
________________________________________
Date
Student Financial Aid Office
11400 Robinwood Drive
Hagerstown, MD 21742
finaid@hagerstowncc.edu
FAX: 301-791-9165
Fall 2020 –
Summer 2021
Income Reduction
Form
Student Financial Aid Office
11400 Robinwood Drive
Hagerstown, MD 21742
Phone: 240-500-2473
finaid@hagerstowncc.edu
FAX: 301-791-9165
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Summer 2021 Income Reduction Form 11400 Robinwood Drive (Hagerstown Community College)

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Completed 20 August 2020

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