Special Circumstances Form

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1 Special Circumstances Form Occasionally, unusual circumstances exist that may warrant reconsideration of financial aid eligibility. If the information you reported on your Free Application for Federal Student Aid (FAFSA) does not accurately reflect your current situation, please submit this form along with any additional documentation to Washington College Office of Student Financial Aid. Due to changes in the federal regulations regarding privacy issues, we can no longer accept any documentation by . All documents must be sent by fax ( ), mail or delivered in person by April 25, Before our office can consider your circumstances, you must have filed the Free Application for Federal Financial Aid (FAFSA). Please note that the following ARE NOT CONSIDERED special circumstances: Credit Card Debt Car Loans, Repairs, Insurance Private School Tuition Private Lessons Self-employment Taxes Legal Expenses Sibling College Expenses Medical Expenses Covered by Insurance Debt Repayment Plans To qualify for any Special Circumstances review, YOU MUST: Complete the FAFSA and have an Expected Family Contribution (EFC) greater than zero Write a letter explaining your particular situation Provide all additional requested documentation, based on your circumstance (see list below) Complete the Verification Worksheet (Part II) and provide the required 2016 documentation Signed copy of 2017 Tax Return or Tax Return Transcript for the student and parent(s) Copy of 2017 W2 and 1099 forms for the student and parent(s) Please Check A. Qualifying Special Circumstances Required Documentation Medical or dental expenses not covered by insurance during Generally, these expenses should be at least 15% of your Adjusted Gross Income (AGI) before submitting documentation. Copy of 2016 IRS 1040 Schedule A itemized deductions from federal tax return Proof of out of pocket expenses not covered by insurance Unemployed or underemployed. Loss or reduction of income in 2017 of at least 20% of total income earned in 2016 B. Termination notice showing the last day of employment or letter from employer showing effective date of wage reduction; Most recent paystubs showing wages earned to date; Proof of unemployment compensation eligibility including total benefit amount

2 Please Check C. Qualifying Special Circumstances in 2016 or 17 Required Documentation Disability. Parent worked full-time in 2016 but has been unable to pursue work for at least 10 weeks during 2016 because of natural disaster or disability. Generally, the 2016 AGI should be at least 20% less than the actual 2015 AGI before submitting documentation. Signed letter from a physician stating the extent and duration of the disability; Disability benefit statement from the Social Security Administration; Last paystub from all employers showing year to date earnings Loss of benefits for at least 10 weeks in 2016 (i.e. Social Security benefits, Child Support, Disability, and Veterans benefits) D. Written statement from appropriate agency showing the loss of benefit andor notarized statement detailing the specific circumstances Legal separated or divorce of parent after submission of your original FAFSA. Please list the date of the separation or divorce: E. Copy divorce or legal separation decree from the court; Copy of supporting parent s most recent pay statement; Documentation of spousal support andor child support F. Death of a parent or spouse Copy of death certificate IWe affirm the information provided on this form and in attached documentation is accurate and complete to the best of our knowledge. IWe understand that completing this form does not guarantee financial aid will be increased. Student signature Date Washington College ID # Parent signature Date

3 PART II Special Circumstances Academic Year Verification Worksheet What should you do? Complete and sign this worksheet. Please read each question carefully. Submit the signed Verification Worksheet and copies of the following documents: a) 2016 Tax Return Transcript(s) for you and your parents. DO NOT SEND A COPY OF A FEDERAL TAX RETURN. Tax Return Transcripts can be requested at: OR b) By using the IRS Data Retrieval Tool (DRT) to transfer the 2016 tax information to the FAFSA. If you are eligible to use the IRS Data Retrieval Tool, we highly recommend that you use it. You can access the DRT at: and AND c) Copies of all 2016 W-2 and 1099 forms for you and your parents. Due to changes in the federal regulations regarding privacy issues, we can no longer accept any documentation by . All documents must be sent by fax ( ), mail or delivered in person. PART A: STUDENT INFORMATION Last Name First Name MI Washington College ID # Street City State Zip Student s address: Student s Cellphone #: Home Phone#: Parent s address Parent s Cellphone#:

4 PART B: FAMILY INFORMATION Please check appropriate box Dependent Students: List all of the people in your household between July 1, 2018 and June 30, Include yourself, your parents, and your parents other children if (a) your parents provide more than half of their support or (b) the children would be required to provide parental information when applying for Federal Student Aid. Include other people only if they now live with your parents and will receive, and continue to receive, more than half their support from them between July 1, 2018 and June 30, If you need more space, attach a separate page. Independent Students: List the people that you (and your spouse) will support between July 1, 2018 and July 30, Include yourself, your spouse, and your dependent children. Include other people only if they now live with you and you provide more than half their support from July 1, 2018 and June 30, If you need more space, attach a separate page. Full Name Age Relationship to student College or University (if will be attending at least half-time Undergraduate or Graduate Expected Month and Year of Graduation Self Washington College Undergraduate PART C: NON-FILERS AND ADDITIONAL UNTAXED INCOME 1) For the student or parent(s) who did not, and are not required, to file a 2016 Federal Income Tax Return per the IRS regulations, please check the appropriate box below: Dependent Student: I did not file and are not required to file a 2016 federal tax return. Parent(s) & Independent Students: I did not file and are not required to file a 2016 federal tax return (see step #2) 2) All non-filer Parents and Independent Students must request and submit a Verification of Non-filing letter, which is proof from the IRS that you did not file a return for the year You can request a Verification of Non-filing letter at the IRS web site listed here: 3) Attach copies of 2016 W-2 form(s) and other earnings statements. If your W-2 is not available, the studentparent(s) must submit a signed statement that indicates the name and address of the employer and the total wages earned in 2016.

5 PART D: ADDITIONAL UNTAXED INCOME RECEIVED IN DO NOT LEAVE ANY FIELDS BLANK. Indicate not applicable by using $0 Student Parent 1. Payments to tax deferred pensions and savings plans (paid directly or withheld from savings). Amounts usually reported on W-2 Forms in Boxes 12a-12d, codes, D, E, F, G, H, and S. 2. Child support received for all children in Do not include adoption or foster payments. 3. Housing, food, and other living allowances paid to members of the military, clergy or others. Do not include the value of on-base military housing or a basic military allowance for housing Veteran s non-education benefits such as Disability, Death Pension, or Dependency & Indemnity, Compensation (DI) andor VA Educational Work-Study Allowances. Other untaxed income not reported, such as worker s compensation, disability, untaxed portions of Health Savings Accounts from IRS Form 1040 Line 25, etc. DO NOT INCLUDE SOCIAL SECURITY 6. Money received, or paid on your behalf, not reported elsewhere on this form if provided by someone other than the parent(s) listed on the FAFSA. (Examples include cash and gifts, plus housing, food and clothing, car payments or expenses, medical and dental care, college costs) or any bills paid on your behalf. Money from a noncustodial parent that is not part of a federal child support agreement is untaxed income to the student. $ XXXXXXXXX PART E: REQUIRED-AUTHORIZATION AND SIGNATURES By signing this worksheet, I certify that all the information reported is correct to the best of my knowledge. In addition, if the Office of Student Financial Aid staff discover any errors in reviewing this form, they make the necessary FAFSA corrections and send them directly to the Department of Education. Student Signature Date Parent Signature Date

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