Change in Income/Employment Special Conditions Appeal Form

Transcription

1 Fairfield University Office of Financial Aid Please completed form to: Or mail to: Office of Financial Aid 1073 North Benson Road Fairfield, CT Fax: Change in Income/Employment Special Conditions Appeal Form Student First Name: Last Name: Fairfield Student ID: Year in School: Academic Year: (i.e ) Phone ( ) - If you believe that there are special conditions that were not considered in your financial aid application(s), or you can now document a change in financial circumstances, subsequent to filing your FAFSA and CSS Profile, please complete this form. Federal regulations and institutional policies require that special conditions fall within certain parameters and that they are accompanied by supporting documentation in order to recalculate financial need and eligibility. This form is designed to assist you in providing information critical to the review of your Special Conditions Appeal. The Special Conditions Appeal decision will be based on the circumstances as detailed in this form and on the accuracy of the additional documentation provided. Appeals will not be reviewed until all required documentation is received. This form will be used to determine your eligibility for additional federal aid. Additional institutional aid is not guaranteed and is based on available funding. If additional funding is granted, appeal awards are for one year only. Instructions: 1. If you are submitting a Special Conditions Appeal, a completed FAFSA and CSS Profile must be on file for you. 2. Please review all sections of this Special Conditions Appeal Form. 3. All applicants must complete Sections: I, II, and IV. Do not leave anything blank in these sections. Write N/A if a question does not apply to you. 4. Once the Special Conditions Appeal Form and the supporting documentation is received, the review process will begin. Section I: Explanation of Special Condition/Circumstance Please attach a separate letter that explains your special circumstance in detail. It will be important to explain and include all relevant information related to your change in circumstance and any other information you feel would allow you to fully explain the circumstance. PLEASE NOTE: If your appeal is on Loss of Employment, 12 or more weeks of unemployment must have passed before submitting this form.

2 Section II: Change in Income Please select the appropriate option and complete the corresponding category below. One-Time/Non-Recurring Income Loss of Other Income Loss of Employment Reduction of Salary in Current Position One-Time/Non-Recurring Income Did you report income that is not an annual source of income? If so, please describe the source of income in a separate statement. Also, describe why this income is not part of your family's annual earnings. Please include the documentation listed below. Document(s) that state the source of the income (i.e. IRA distribution, sale of property, inheritance, Form 1099) and confirm that the income is non-recurring. Explanation of how the income was used and how much is being reported as an asset. Tax returns from the prior year to confirm the benefit was not also received in prior years. Loss of Other Income Did you lose a reported source of other income (non-wage)? Examples include the termination or reduction of benefits including social security, child support, etc. If so, please document the change. Please include the documentation listed below. Copy of a notice of benefit termination or change in benefit. Copy of a court order that specifies when the benefit payments will cease.

3 PLEASE NOTE: Loss of employment must be for a period of equal to or more than 12 weeks before this form can be submitted. On what date did you become unemployed? (mm/dd/yy) Loss of Employment What were your yearly gross earnings prior to becoming unemployed? Date of Re-Employment: Did you regain employment (i.e. find a new job and/or regain your old job)? Gross Monthly Salary: Severance Package: Please indicate the dollar amounts for the following compensation: Accrued Sick Leave / Vacation Time Date Unemployment Compensation began: Do you receive unemployment compensation? Yes No Weekly Amount of Compensation: Number of weeks you will be receiving compensation (in total): Do you receive any other benefits (workman s compensation, etc.) due to the loss of employment? Please describe the dollar amount and the nature of these benefits: Most recent pay stub for all current income-earners in the household. Copy of the last/most recent pay stub from the previous employer. Letter from previous employer indicating the last date of employment and the amount of benefits being paid out (i.e. severance, vacation pay, etc.) Copy of unemployment benefits.

4 Reduction of Salary On what date did your reduced salary become effective? (mm/dd/yy) What was your monthly salary prior to the reduction? What is your current (reduced) monthly salary? Most recent pay stub for all current income-earners in the household. Letter from employer that verifies your job status/change and pay rate. Benefits being paid out (workman s compensation, etc). Section III: Verification All students requesting a Special Conditions Appeal are subject to the Verification process. A separate request for verification documents will be sent to the student, once the Office of Financial Aid has reviewed the appeal. These documents may include, but are not limited to: current tax returns and/or official IRS Transcripts, W2s forms, verification worksheets, etc. PLEASE NOTE: The verification process, which in some cases may be required prior to processing an appeal, can result in an initial decrease/increase to a student s originally estimated aid offer. The appeal process may not restore any reduced aid or offer additional aid.

5 Section IV: Certification By signing below, 1. We affirm that the data contained on this form and on all attached supporting documentation is true and complete to the best of our knowledge. 2. We acknowledge that submission of an appeal does not guarantee an adjustment to the student s award. 3. We recognize that submission of an appeal does not prevent the accrual of late fees on unpaid balances. 4. We will make arrangements to pay our bill on time and not wait for the outcome of this appeal. 5. We understand that if any of our projections change, we will immediately notify the Office of Financial Aid. 6. We will provide all required documents as requested, to the Office of Financial Aid, and understand that my appeal will not be processed until all documents are submitted. Students will be notified, in writing, of the special conditions appeal decision. Please print, sign and submit this form, including all supporting documentation, to the Office of Financial Aid. Student Signature Date Parent Signature Date Office use only: APLTR1