2014-2015 SPECIAL CIRCUMSTANCE APPLICATION Student Name: Student ID: Address: Street City State Zip Daytime Phone: KSU Email: The purpose of a Special Circumstance application is to explain that the information submitted on the Free Application for Federal Student Aid (FAFSA) is not an accurate representation of the family s financial situation for 2014. If approved, an adjustment to your Expected Family Contribution (EFC) may occur. These adjustments will only be made if the income information reported on your 2013 Federal Taxes is greater than your anticipated 2014 income with the exceptions of a parent in college, medical expenses, and educational expenses. This application must be received by February 1, 2015. Important Information and Instructions: Submit all required documentation under the section(s) that match your circumstances. Complete and return pages 1-5 with all required supporting documentation to the Student Financial Aid Office at the Kent campus. All Special Circumstance Applications are reviewed and processed in the date order in which they were received at the Student Financial Aid Office. Messages related to the Special Circumstance Application will be posted to the student s FlashLine account at https://flashline.kent.edu. Directions on how to view your messages can be found on our website at www.kent.edu/financialaid. IF YOU DID NOT FILE TAXES FOR 2013 PLEASE SIGN THE NON-FILING STATEMENT Complete this section only if the student, student s spouse, or student s parent(s) DID NOT FILE A 2013 TAX RETURN. If you received a 2013 IRS W-2 or 1099, provide a copy with this application. Student Signature Date Student s Spouse Signature Date Parent 1 Signature Date Parent 2 Signature Date CERTIFICATION STATEMENT Must be signed by the student, the student s spouse, and the student s parents (if applicable) All information on this application is true and complete to the best of my knowledge. If requested, I agree to provide further documentation to substantiate the information provided. I understand that any false information may result in cancellation of any current or future financial aid award(s) and that I may be required to repay any financial aid that was awarded based on the recalculation of the Expected Family Contribution (EFC). Student Signature Date Student s Spouse Signature Date Parent 1 Signature Date Parent 2 Signature Date 1
PLEASE USE THE CHECK LISTS BELOW TO ENSURE YOU HAVE INCLUDED ALL NECESSARY DOCUMENTS Documents within this box need to be submitted with every application If you did not file 2013 federal taxes, please sign the Non-Filing Statement on Page 1 A signed copy of student and/or spouse s 2013 Federal Tax Return or Tax Transcript including any schedules filed. A copy of student and/or spouse s 2013 W-2s for all employers. W-2s must equal wages on tax forms. A signed copy of parents 2013 Federal Tax Return or Tax Transcript along with any schedules filed. If parents filed married filing separately, please submit copies of both parents tax forms. A copy of parents 2013 W-2s for all employers. W-2s must equal wages on tax forms. A copy of the most recent 2014 paycheck stub showing year-to-date amount for the student, student s spouse, Parent 1 and Parent 2. Paycheck stubs are not needed for medical or educational expenses or parent in college. If you have a home-based business, please submit a signed statement of projected income for 2014. A copy of all 2014 documentation that verifies all untaxed income reported on the 2014-2015 FAFSA (e.g. child support, Social Security Income and Disability Income). ~PLEASE CHECK THE REASON FOR YOUR SPECIAL CIRCUMSTANCE PROVIDE ALL ADDITIONAL DOCUMENTS LISTED BELOW YOUR SITUATION. Loss of Working Income: Please circle individual with the loss Parent 1 Parent 2 Student Spouse Letter of separation from employer that states the last day of employment. You must be laid off at least 10 weeks prior to submitting this application. Copy of final pay stub from previous job. Copy of most recent pay stub from current job(s). Copy of unemployment statement, unemployment check stub or statement of ineligibility for unemployment benefits. If you are receiving unemployment/severance etc., please include documentation of total payments anticipated/received between Jan Dec 2014 Reduction in Wages If reduced hours/wages, a current paystub showing reduced hours/wages. Loss of Benefits or Untaxed Income: Please circle below Alimony Child Support Workman s Comp Social Security/Disability Unemployment Court documents such as separation/divorce decree stating effective date of change. Letter from agency stating last date of payment and total amount received/anticipated from Jan-Dec 2014. Divorce/Separation: Must have occurred after submitting the FAFSA. Income will be used for both individuals prior to the separation date. A copy of separation/divorce decree, letter from attorney stating the separation or divorce date. Documentation of separate addresses, such as utility bills, lease, etc. Death of a Parent: A copy of death certificate, obituary or death notice. (Continued on page 3) 2
Parent in College: How many family members total in college? Copy of the parent s tuition bill for the Summer 2014, Fall 2014, or Spring 2015 term. Medical/Dental or Elementary/Secondary Tuition Expenses: A copy of 2013 Schedule A, canceled checks, or receipts indicating amounts that have been paid for (not billed) by you (not your insurance company) in 2013. Expenses have to equal or be greater than 10% of your 2013 household adjusted gross income. A letter from K-12 school stating amount paid by you for 2013. This does not include scholarships or grants received Jan Dec 2013. Paid tuition expenses have to equal or be greater than 10% of your 2013 household adjusted gross income. Lump sum Income or Pension/401k Withdrawal included in 2013 Adjusted Gross Income and reported on the FAFSA Note: This is a one-time special circumstance consideration. Received an inheritance or withdrew a lump sum pension/ira/social security payment in 2013. Documentation that identifies source of income or withdrawal of funds and the amount. Documentation on how funds were spent or invested and why they are not available as a resource for 2014. Please submit paid invoices, canceled checks, and/or receipts. Spent funds will be reviewed. If funds were used for luxury items, vacation, home renovations, etc., the application will not be approved. Use this section to provide a detailed explanation of what has changed for the family financially since the end of 2013. Include dollar amounts, dates, and attach appropriate documentation to support reasons for filing the Special Circumstance Application. 3
Projected 2014 Income Report all income you have actually received from January 1, 2014 through today. Then estimate all income you expect to receive from today through December 31, 2014 2014 Wages for Parent 1 2014 Wages for Parent 2 Interest Income and Dividends Alimony Received Business and/or Farm Income Capital Gains Pensions and Annuities (taxable amount) IRA Distributions (excluding rollovers) Rental Income Taxable Social Security Benefits Unemployment Compensation TOTAL TAXABLE INCOME FOR 2014 Payments to Tax Deferred Pensions such as 401(K) or 403(B) IRA, Keogh, and/or SIMPLE Payment Social Security Benefits Child Support Received Public Assistance (Welfare, TANF, WIC, others) Disability, Death Pension,Worker's Compensation Other PARENT TAXABLE INCOME FOR JANUARY 1, 2014 - DECEMBER 31, 2014 PARENT UNTAXABLE INCOME FOR JANUARY 1, 2014 - DECEMBER 31, 2014 TOTAL UNTAXABLE INCOME FOR 2014 STUDENT TAXABLE INCOME FOR JANUARY 1, 2014 - DECEMBER 31, 2014 2014 Wages for Student 2014 Wages for Student's Spouse Interest Income and Dividends Alimony Received Business and/or Farm Income Capital Gains Pensions and Annuities (taxable amount) IRA Distributions (excluding rollovers) Rental Income Taxable Social Security Benefits Unemployment Compensation TOTAL TAXABLE INCOME FOR 2014 STUDENT UNTAXABLE INCOME FOR JANUARY 1, 2014 - DECEMBER 31, 2014 Payments to Tax Deferred Pensions such as 401(K) or 403(B) IRA, Keogh, and/or SIMPLE Payment Social Security Benefits Child Support Received Public Assistance (Welfare, TANF, WIC, others) Disability, Death Pension, Worker's Compensation Other TOTAL UNTAXABLE INCOME FOR 2014 4
IMPORTANT NOTICE: If you are selected to complete our Verification process, it must be completed before the Special Circumstance Application can be reviewed. In order to be considered for any adjustments, the student must be admitted and meet all federal eligibility requirements when the Special Circumstance application is received. An adjustment to the Expected Family Contribution might not result in additional financial aid. Processing of this application takes 2-4 weeks from the time all requested documents have been received. You will still be held responsible for any balances owed to the University while waiting for this application to be reviewed. Failure to furnish all the required documentation when submitting the application may delay the review process and/or result in the denial of your request. If the circumstance only pertains to the parent, we still take into consideration the student s 2014 anticipated income. Please include their documentation as well. The application deadline is February 1, 2015. Mail to: Student Financial Aid Office Phone: (330) 672-2972 Attn: Professional Judgment Fax: (330) 672-4014 800 East Summit Street Location: 103 Schwartz Center P.O. Box 5190 Email: finaid@kent.edu Kent, OH 44242-0001 Website: www.kent.edu/financialaid For Office Use Only: Prior Year Application? Yes No Verify prior ROANYUD Yes No Application Decision Approved Denied Calculation 75% x AGI from 2013 Taxes > RNANA14 Revised 3/31/2014 5