*** You may only submit one Employment Adjustment Form for 2019‐20***
Which income year are you subming for review?
(Only check one)
Provide the following informaon for the selected year:
_____ Parent Income Adjustment—Parents must aach all documentaon listed above.
No earned income
_____ Student and/or spouse Income Adjustment*—Student and spouse must aach all documentaon listed above.
No earned income
*NOTE: Dependent students must submit signed copies of the Federal Tax Return and W‐2s for both parent and student regard‐
less of whose income changed.
All of the informaon provided by me, or any other person, is true and complete to the best of my knowledge. I understand that
purposely giving false or misleading informaon may subject me to ﬁnes, penales, and/or terminaon of ﬁnancial aid. Adobe or
signature type fonts will not be accepted.
Student signature Date Parent signature
(dependent students only) Date
Use this form only if you have experienced a signiﬁcant change of employment or unemployment income (approximately 10% or
more in income) aer you ﬁled your 2019‐20 FAFSA. For other requests for income adjustments, use the Special Condions Form.
This form is used to request a review of your ﬁnancial aid eligibility as a result of a signiﬁcant change in employment income for
you, your spouse and/or parent(s) during the 2018 or 2019 calendar year.
Please note: It is the policy of this college not to base ﬁnancial aid adjustments on projecons or esmates for future income.
Submission of this form does not guarantee an increase to your ﬁnancial aid eligibility.
Documentaon Required: When you and/or your parent(s) have completed your 2018 or 2019 Federal Tax Return,
Complete Employment Adjustment Form
Submit a signed copy of your Federal Tax Return including all schedules or Tax Transcript for the appropriate year
Submit copies of all your W‐2s for the appropriate year
Submit a signed statement of any other untaxed income for the appropriate year. (disability, non‐educaonal VA beneﬁts, ect.)
Your adjustment will be reviewed and if an adjustment is warranted, it will be retroacve to the ﬁrst term you aended during the
2019‐20 academic year.
IMPORTANT: Please only submit copies of the documents we request. All documents submied become the property of the
Financial Aid Oﬃce and will not be returned or loaned to the student or the parent to photocopy. Please allow up to 4 weeks for
processing of this adjustment. Submission of this adjustment does not ensure a change or increase in your award. You will be no‐
ﬁed of the results.
Financial Aid Oﬃce
541.383.7260 • fax: 541.383.7506
2600 NW College Way, Bend, Oregon 97703
www.cocc.edu/ﬁnancial‐aid • e‐mail: coccﬁnaid@cocc.edu
Oﬃce use only
Student name COCC ID number