*** You may only submit one Employment Adjustment Form for 2019‐20***
Which income year are you subming for review?
(Only check one)
 2018
 2019
Provide the following informaon for the selected year:
_____ Parent Income Adjustment—Parents must aach all documentaon listed above.
 No earned income
_____ Student and/or spouse Income Adjustment*—Student and spouse must aach all documentaon 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 informaon 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 informaon may subject me tones, penales, and/or terminaon ofnancial 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) aer you filed your 201920 FAFSA. For other requests for income adjustments, use the Special Condions 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 projecons or esmates for future income.
 Submission of this form does not guarantee an increase to your nancial aid eligibility.
Documentaon 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‐educaonal VA benefits, ect.)
Your adjustment will be reviewed and if an adjustment is warranted, it will be retroacve to the first term you aended during the
2019‐20 academic year.
IMPORTANT: Please only submit copies of the documents we request. All documents submied 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.
Employment Adjustment
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
Approved Denied
Student name COCC ID number