2018-2019 Special Circumstance Review Request Form Student Name: of Birth (MM/DD/YY): Program: Major: Last 4 digits of SSN: xxx-xx- Daytime Phone Student: Time Zone if different than EST: In cases where there is an involuntary, recent and documentable change in financial circumstances, the CIM Financial Aid Office may consider specific data element change(s) to the 18-19 FAFSA. This will allow institutional reprocessing of the FAFSA to be based on more current financial scenario than was originally submitted on the FAFSA using the 2016 federal tax return data. Such changes do not always result in additional aid eligibility. The CIM Financial Aid Committee will review your review request and respond as soon as possible upon receipt of ALL required information. For all reviews, the 18-19 Verification Form(s) must be completed BEFORE this review may occur. These forms are found on the NetPartner forms/links screen. For undergraduates, this includes both the Parent and Student Verification Forms. Graduate students only need to submit the Student Verification Form. We may only consider changes to the student finances, not that of parents, for graduate students. The parent assumed contribution on the FAFSA for all graduate students is already $0, by default. Required for all review requests: Step 1: Write a detailed description of your special circumstance(s) and submit with this form. This is required for all appeals. This step may also be emailed to the Financial Aid Office at financialaid@cim.edu. Check here if this section s detail is being emailed:
Step 2: Check the box(es) that best describe your situation and submit this completed form along with the supporting documentation. *Depending on the date of change, 2017 or 2018 records may be needed instead of 2016 documents noted below. Submit whatever documentation is the MOST RECENT year applicable to the change. CHECK BOX REASON FOR APPEAL Recent death of Student s parent or spouse. The student or parent(s) no longer receives benefits such as child support, taxable social security, or other sources of income. Extraordinary family medical/dental expenses paid Decrease in work hours or reduction of income. The student or the student s parents have separated or divorced. Loss of job for the student or parent(s). REQUIRED DOCUMENTATION Copy of the parent s or spouse s death certificate If taxes were filed jointly, complete the Estimated Income Form (for parents or student/spouse as applicable), see last pages 2016 W-2 and/or 1099-MISC for each person applicable to student s FAFSA (we need to document how much of the annual income was attributable to the deceased). If benefits are terminated - documentation of the monthly benefit amount received and date of benefit termination If benefits are reduced documentation of both original amount, date of reduction, and reduced amount Submit a 2016 IRS 1040 Schedule A if you itemized medical expenses. If you did not itemize, submit proof of medical expenses paid in 2016. An insurance Explanation of Benefit (EOB) is not acceptable documentation. Please do not send cancelled checks. Final pay stub before change Current pay stub showing change Dependent Student (generally, most undergraduates) Submit letters from both parents stating the date of separation and identifying the parent providing primary financial support for the student and household size and who will be the custodial parent going forward. The parent not providing primary support should state how much support (if any) will be given monthly to the custodial parent for all family members. Utility bills from each parent to substantiate two separate households are now being maintained. 2016 W-2 and/or 1099-MISC for each person applicable to student s FAFSA (we need to document how much of the annual income was attributable to each parent). Independent Student (all graduate students) Submit a separate letter listing any dependents and include the amount of support payments (if any) provided to the student or dependents 2016 W-2 and/or 1099-MISC for both student and spouse (need to document how much of the income was attributable to each person). Documentation of unemployment benefits Copy of separation notice Final pay stub & documentation of severance pay (if applicable) Parent or student has received a one-time disbursement of funds. Other extenuating circumstances. not listed above Documentation of fund amount and the source of the funding Examples may include severance package, bonus, IRA early withdrawal etc. Detailed letter describing the extraordinary situation **Additional documentation will likely be requested. Step 3: FAFSA U.S. Citizens and Permanent Residents must have a valid 18-19 FAFSA on file (https://fafsa.ed.gov/). Also, the 18-19 Verification Form (Student) is required, and 18-19 Verification Form (Parent) is required for dependent students. These forms are found on your NetPartner Forms/Links screen. Step 4: Complete both Parent and Student Special Circumstances pages that follow, unless otherwise noted.
Parent(s) Special Circumstances Documentation This page is not applicable to U.S. citizen or Permanent Resident Graduate Students, as the parent contribution is already assumed to be zero for you, per FAFSA financial need formulas, which excludes any parent income/asset information. As such, financial special circumstances relating to parents of U.S. citizen or Permanent Resident graduate students are therefore not applicable for appeal review. Instructions: Provide actual and estimated 2018 income for the parent/stepparent(s) whose information was used to complete the 2018-2019 FAFSA. If biological/legal parents are separated or divorced, report on the parent (and their spouse, if remarried) who you lived with more in the past 12 months. For any income listed, submit supporting documentation as specified on the appeal form. If a line item is left blank, you are certifying you have not received and there is no expectation of receiving income of that kind. If appeal is approved and there is any change to federal need-based aid due to FAFSA adjustment by the CIM Financial Aid Office, this page must be updated and resubmitted between 8/1/18 and 8/15/18 to the show more recent updated yearly income projections. Sources of Income Actual amounts from 1/1/2018 through today Expected amounts from tomorrow through 12/31/2018 TAXABLEINCOME Parent 1 / stepparent gross earnings from employer(s) $ $ Parent 2 / stepparent gross earnings from employer(s) $ $ Severance Pay $ $ Investment Income: Dividends, Net Rental Income, etc. $ $ Alimony Received $ $ Business Net Income $ $ Capital Gains (Sale of Property, etc.) $ $ IRA/Retirement Account Withdrawals $ $ Pension and Annuity Income $ $ Corporation & Partnership Income $ $ Farm/Ranch Net Income $ $ Unemployment Compensation (Gross) $ $ Taxable Social Security Benefits/Disability $ $ UNTAXED INCOME Payments to Tax-Deferred Pension and Savings Plans $ $ IRA Deductions/Payments to SEP, SIMPLE, Koegh $ $ Child Support Received $ $ Tax Exempt Interest Income $ $ Untaxed Portions of IRA Distributions $ $ Untaxed Pension and Annuity Income $ $ Housing, Food and Other Living Allowances paid to you $ $ Non-Educational Veterans Benefits $ $ Other Untaxed Income (Workers Compensation/Disability) $ $ ADDITIONAL FINANCIAL INFORMATION Child Support Paid $ $ Taxable Combat Pay or Special Combat Pay $ $ Financial support from others outside of your household $ $ Any other income: $ $ TOTAL INCOME $ $ Parent 1 Printed Name Parent 2 Printed Name Parent 1 Email (or Daytime Phone #) Parent 2 Email (or Daytime Phone #) Parent 1 Signature Parent 2 Signature
Student/Spouse Special Circumstances Documentation Instructions: Provide actual and estimated 2018 income for the Student/Spouse. For any income listed, submit supporting documentation as specified on the appeal form. If a line item is left blank, you are certifying you have not received and there is no expectation of receiving income of that kind. If appeal is approved and there is any change to federal need-based aid due to FAFSA adjustment by the CIM Financial Aid Office, this page will need to be updated and resubmitted between 8/1/18 and 8/15/18 to the show more recent updated yearly income projections. Sources of Income Actual amounts from 1/1/2018 through today Expected amounts from tomorrow through 12/31/2018 TAXABLE INCOME Student gross earnings from employer(s) $ $ Spouse gross earnings from employer(s) $ $ Severance Pay $ $ Investment Income: Dividends, Net Rental Income, etc. $ $ Alimony Received $ $ Business Net Income $ $ Capital Gains (Sale of Property, etc.) $ $ IRA/Retirement Account Withdrawals $ $ Pension and Annuity Income $ $ Corporation & Partnership Income $ $ Farm/Ranch Net Income $ $ Unemployment Compensation (Gross) $ $ Taxable Social Security Benefits/Disability $ $ UNTAXED INCOME Payments to Tax-Deferred Pension and Savings Plans $ $ IRA Deductions/Payments to SEP, SIMPLE, Koegh $ $ Child Support Received $ $ Tax Exempt Interest Income $ $ Untaxed Portions of IRA Distributions $ $ Untaxed Pension and Annuity Income $ $ Housing, Food and Other Living Allowances paid to you $ $ Non-Educational Veterans Benefits $ $ Other Untaxed Income (Workers Compensation/Disability) $ $ ADDITIONAL FINANCIAL INFORMATION Child Support Paid $ $ Taxable Combat Pay or Special Combat Pay $ $ Financial support from others outside of your household $ $ Any other income: $ $ TOTAL INCOME $ $ Student Printed Name Spouse Printed Name Student Email (or Daytime Phone #) Spouse Email (or Daytime Phone #) Student Signature Spouse Signature
Step 7: Certification: I certify that all of the information provided on this form (all pages) and attached documentation is correct and complete to the best of my knowledge. I will notify the CIM Financial Aid Office immediately in writing of any changes that occur that pertain to this appeal. Example: if appeal is due to loss of job and a new job is obtained before the 2018 year is over, I understand I must communicate the updated estimated 2018 income to CIM. Student Signature / Parent Signature (for Dependent students) / Or Signature of Student s Spouse/ Step 8: Please return this form and all requested documentation: Fax: 216-791-1530 *Email: clearly labeled pdf to financialaid@cim.edu Mail: CIM Financial Aid Office, 11021 East Blvd., Cleveland, OH 44106 *NEVER SEND ANY FILES VIA EMAIL THAT INCLUDE SSN UNLESS THE FILE IS ENCRYPTED AND THE PASSWORD IS SENT IN A SEPARATE EMAIL. THIS IS DEPT OF EDUCATION REGULATIONS AND HELPS PROTECT YOU FROM IDENTITY THEFT.