Instructions 2013-2014 You have indicated that you and/or your family have experienced a significant change in your financial situation during 2012. We understand this may be a difficult time for you and your family. Depending on your special circumstances, the Office of Student Financial Assistance may be able to reevaluate your eligibility for financial aid for the 2013-2014 academic year. Our reevaluation is based on the information you provide with this application. Please note that not all changes in circumstances can result in an adjustment to your financial aid eligibility. YOUR NEXT STEPS 1 Important: You are required to file a 2013-2014 Free Application for Federal Student Aid [FAFSA] before submitting this form or any materials to the Office of Student Financial Assistance. If you have not yet completed a FAFSA, you can do so online at www.fafsa.ed.gov. 2 If you ve filed your FAFSA, please review the circumstances listed in Sections 1 through 4 of this application and choose one that applies to your situation. Choose ONE situation from either Sections 1, 2 or 3 [dealing with loss of taxable income, untaxed income, or a family member] OR from Section 4 [dealing with additional expenses]. 3 After identifying your circumstance, gather all the documentation required for your situation, as listed in the section that matches your situation. 4 Complete Sections 5 and 6 of this form, plus the 2013 2014 Verification Worksheet [also attached]. 5 Submit all required information and documents for your circumstances, plus completed Sections 5 and 6, and the Verification Worksheet. Be sure to also include copies of parents 2012 federal tax return transcripts [for dependent students] and the student s 2012 federal tax return transcript. To request an official 2012 tax return transcript from the Internal Revenue Service, you may call 800-908-9946 or request one at www.irs.gov. 6 Send all materials to the Office of Student Financial Assistance, Xavier University: Mail: 3800 Victory Parkway, Cincinnati, OH 45207-5111 Fax: 513-745-2806 Email: xufinaid@xavier.edu XAVIER S NEXT STEPS 1 If you submit a completed form and all required documents, the Office of Student Financial Assistance reviews your appeal. Note that if the form is incomplete or documents are missing, your materials will be returned and your review will be delayed. 2 After the Office of Student Financial Assistance completes its review of your appeal, you will be notified by email within 10 business days about the outcome of your Special Circumstance Appeal. 3 We will not consider the following reasons that result in a decline in family income or an increase in expenses: One-time capital gains or IRA distributions, or one-time severance pay Capital gains resulting in early withdrawal of retirement fund Costs related to bankruptcy Expenses related to a parent who has returned to college Loss of windfall income such as lottery, gambling, or bonus income Unusual expenses related to personal living such as wedding expenses, credit card bills, home mortgage, school loan payments, car payments, or other miscellaneous consumer expenses
SECTIONS 1-4 SITUATIONS & DOCUMENTATION The following sections list various situations that describe significant changes in the financial situation for students and families. Select the description that best applies to you. Choose your situation from either Sections 1, 2 or 3 OR from Section 4, but not from both areas. Next to each situation you will see the required documentation that you must gather and submit, along with your completed application [Sections 5 and 6] and the Verification Worksheet. 1. LOSS OF TAXABLE INCOME A B SITUATION Loss of job [must be unemployed for at least 6 weeks] [If you held more than one job but are no longer working at any of them, you are required to provide verification of nonemployment for each.] Change of job that resulted in a reduction of earnings DOCUMENTATION REQUIRED Copies of all 2012 W-2s Copy of last pay statement or a letter from a previous employer indicating year-to-date earnings Copy of unemployment letter Copy of last pay statement showing prior salary Copy of most recent pay statement Letter from employer stating new salary/rate of pay C Loss of job due to disability Copy of final pay statement Documentation of monthly income benefits received or anticipated amount D E F Loss of wages due to permanent wage reduction Loss of commissions Loss of mandatory overtime Copy of last pay statement at prior rate Copy of recent pay statement showing loss of income Provide documentation of change from employer 2. LOSS OF UNTAXED INCOME SITUATION DOCUMENTATION REQUIRED A Loss of child support Copies of all 2012 W-2s Copy of notice showing benefit termination or court order that specifies when payments cease 2 XAVIER UNIVERSITY xavier.edu
SECTIONS 1-4 cont. A B 3. LOSS OF A FAMILY MEMBER SITUATION Death of a parent or spouse after FAFSA has been filed Divorce or separation after FAFSA has been filed [The couple may not be residing in the same household.] DOCUMENTATION REQUIRED Copies of all 2012 W-2s Copy of death certificate Copies of all 2012 W-2s to separate out income Documentation to verify the divorce/separation which may include court judgment entry, letter from attorney or clergy person A B 4. ADDITIONAL EXPENSES SITUATION Medical, dental, vision, prescription expenses not covered by insurance [Medical expenses must be paid. Anticipated medical expenses will not be considered.] Private school tuition paid [Please contact your financial aid counselor first before filling out the form to learn if the amount of tuition you paid will have an impact on your aid package.] DOCUMENTATION REQUIRED A copy of IRS Schedule A Itemized Deductions Note: Explanation of benefits from your insurance company will not be considered as proof of payment. Statement or letter from the school showing actual tuition amount paid for the previous 2012-2013 school year Please do not include incoming student xavier.edu XAVIER UNIVERSITY 3
SECTIONS 5-6 Application for Appeal Please complete Sections 5 and 6 plus the 2013-2014 Verification Worksheet [also attached]. If an item doesn t apply, please put a 0 in the field. Also submit copies of parents 2012 federal tax return transcripts [for dependent students] and the student s 2012 federal tax return transcript. Send all completed forms and required documentation to: Office of Student Financial Assistance, Xavier University, 3800 Victory Parkway, Cincinnati, OH 45207; fax 513-745-2806; or email xufinaid@xavier.edu. Student s Name Xavier ID/SSN Daytime Phone [in case of questions] Email 5. Estimated 2013 Income Worksheet Mother [dependent students] Father [dependent students] Student Spouse [independent student] Gross earnings received from work 1/1/2013 until today Gross earnings from work from today until 12/31/2013 Last date of employment Interest and/or dividend income Taxable pensions/annuities, IRA distributions Unemployment compensation Taxable Social Security benefits Other taxed income [i.e. business, rental] Total taxable income Tax exempt interest income Workers compensation Child support received Contributions to tax-deferred IRA/pension/savings plan Other untaxed income from: Total non-taxable income 4 XAVIER UNIVERSITY xavier.edu
SECTIONS 5-6 cont. 6. Explain Your Circumstances 1 Please indicate here the circumstances/situation you selected from the previous descriptions: Section number/letter: 2 In the following section, please explain the change in your financial situation. Include dates and other details, as this information is essential to our review. By signing this Special Circumstances Appeal Form, I [we] certify that all the information reported on this worksheet is complete and correct. I understand that this appeal will not be reviewed until all required documentation is submitted and the 2013-2014 FAFSA is on file with Xavier University. I [the student] authorize the staff of the Office of Student Financial Assistance at Xavier University to discuss this matter with my parent(s) or guardian(s) whose information is included on this form. Student Signature Date Parent Signature Date Xavier Use Only Revised AGI Revised federal tax Verified EFC New EFC FAA Initials Date of Letter Comments Approved Not Approved REV. 2/13 xavier.edu XAVIER UNIVERSITY 5
Federal Student Aid Programs 2013-2014 VERIFICATION WORKSHEET [V1] Your application was selected for review by the U.S. Department of Education in a process called verification. This process requires Xavier University by federal law [34 CFR, Part 668] to compare the information from your application with the information provided on this form. Also, please submit copies of your 2012 federal tax return transcripts [and your spouse s if you are married, or your parents if you are considered dependent for federal aid purposes]. If there are differences between your application and the documents you ve submitted, a staff member in the Office of Student Financial Assistance will make corrections. We cannot process your financial aid application until verification has been completed. Please provide the required documents as soon as possible. WHAT YOU SHOULD DO 1 Collect your [and your spouse s or parents ] financial documents. Students and/or parents must contact the IRS to obtain official transcripts by phone at 800-908-9946 or online at www.irs.gov. If you (and your spouse and/or parent(s) selected the IRS Data Retrieval process on the FAFSA then your tax transcripts are not required however we still need a copy of your and your spouse s/parent(s) W-2(s) along with this worksheet. If you and/or your parents are eligible to use the IRS Data Retrieval Process, but did not, you are encouraged to return to your online FAFSA and use the IRS tool to update your or your parent(s) tax information. Taxes must be filled out at least two weeks prior to using the IRS Data Retrieval Process. 2 Complete all sections and sign the worksheet. 3 Return the completed worksheet, tax forms and any other documents to the Office of Student Financial Assistance, Xavier University: Mail: 3800 Victory Parkway, Cincinnati, OH 45207-5111 Fax: 513-745-2806 Email: xufinaid@xavier.edu 4 Xavier will review the information on these documents and make corrections if necessary. If you have questions about _ completing this worksheet, please contact us at 513-745-3142. A STUDENT INFORMATION [PLEASE PRINT] Last Name First Name M.I. Xavier ID/SSN Address [include apt. #] City State Zip Code Date of Birth Student Email Address Daytime Phone [include area code] Parent Email Address 1 XAVIER UNIVERSITY xavier.edu
2013-2014 VERIFICATION WORKSHEET [V1] cont. B FAMILY INFORMATION Independent Students: List the people in your household, including: [a] yourself, and your spouse if you have one; and [b] your children, if you will provide more than half of their support from July 1, 2013, through June 30, 2014; and [c] other people if they now live with you, and you provide more than half of their support and will continue to provide more than half of their support from July 1, 2013, through June 30, 2014. Dependent Students: List the people in your parents household, including: [a] yourself and your parent(s) [including stepparent] even if you don t live with your parents; and [b] your parents other children, even if they don t live with your parent(s), if [1] your parents provide more than half of their support from July 1, 2013, through June 30, 2014, or [2] the children would be required to provide parental information when applying for federal student aid; and [c] other people if they now live with your parents, and your parents provide more than half of their support and will continue to provide more than half of their support from July 1, 2013, through June 30, 2014. Write the names of all household members. Also write in the name of the college for any family member, excluding your parent(s), who will be attending college at least half-time between July 1, 2013, and June 30, 2014, and will be enrolled in a degree, diploma or certificate program. If you need more space, attach a separate page. Full Name Age Relationship College Self Xavier University During 2012 was child support paid by any member of the household listed above? No Yes* *If yes: Name of household member who paid support Amount of child support paid in 2012: Name of person to whom child support was paid in 2012: Name of child(ren) for whom child support was paid in 2012:** Signature of member who paid child support ** Children listed should not be included in the FAFSA for number in the household. C TAX FORMS AND INCOME INFORMATION All tax filers must submit a copy of their 2012 federal tax return transcript and a copy of all W-2s. Please check here if you and/or your parent(s) successfully used the IRS Data Retrieval Process. You Your spouse Your father [step] Your mother [step] Check the box for those people who did not and are not required to file a 2012 federal income tax return. List below your employer(s) and any income received in 2012 [use W-2 forms or other earning statements]. A W-2 must be submitted for each source of income. You Your spouse Your father [step] Your mother [step] Name of Employer Student Amount Spouse or Parent(s) Amount 2 XAVIER UNIVERSITY xavier.edu
2013-2014 VERIFICATION WORKSHEET [V1] cont. C TAX FORMS AND INCOME INFORMATION [CONT.] Both tax filers and non-tax filers must list any untaxed income received in 2012. Be sure to enter zeros if no funds were received. [In the Free Application for Federal Student Aid [FAFSA]: Students, see question 44, and/ or parents, see question 92.] Failure to complete this section will delay the processing of your financial aid. Student [spouse] Calendar Year 2012 FAFSA Questions 44 and/or 92 Parent(s) [step-parent] Payments to tax-deferred pensions and savings plans [paid directly or withheld from earnings] including, but not limited to, amounts reported on W-2 Form Box 12a - 12d, codes D, E, F, G, H, and S. IRA deductions and payments to self-employed SEP, SIMPLE, and Keogh and other qualified plans from IRS Form 1040 line 28 + line 32 or 1040A line 17. Tax exempt interest income from IRS Form 1040 line 8b or 1040A line 8b. Untaxed portions of IRA distributions from IRS Form 1040 lines [15a minus 15b] or 1040A lines [12a minus 12b]. Exclude rollovers. If negative, enter a zero here. Untaxed portions of pensions from IRS Form 1040 lines [16a minus 16b] or 1040A lines [12a minus 12b]. Exclude rollovers. If negative, enter a zero here. Housing, food and other living allowances paid to members of the military, clergy and others [including cash payments and cash value of benefits]. Did anyone in the household receive SNAP benefits during 2011 or 2012? Yes No D SIGN THIS WORKSHEET By signing this worksheet, I [we] certify that all the information reported on this worksheet is complete and correct. If dependent, at least one parent must sign. Warning: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both. Student Signature Date Parent Signature [dependent students only] Date Return to: Office of Student Financial Assistance, Xavier University Mail: 3800 Victory Parkway, Cincinnati, OH 45207-5111 Fax: 513-745-2806 Email: xufinaid@xavier.edu 3 XAVIER UNIVERSITY xavier.edu REV. 2/13