Fillable 2020-21 Special Circumstances Appeal Dependent Student (Eastern Florida State College)

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2020-21 Special Circumstances Appeal Dependent Student (Eastern Florida State College)

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EFSC Office of Financial Aid
www.easternflorida.edu/go/aid | (321) 433-7339 | finaid@easternflorida.edu
1 05/28/20
SPECL
FA Professional
Judgement
2020-21 Special Circumstances Appeal
Dependent Student
The Office of Financial Aid recognizes that families may experience a change in their financial situations after the Free
Application for Federal Student Aid (FAFSA) has been filed. You should use this form only if your family has experienced
a significant change in income, has unusual medical or dental expenses, or has other unusual circumstances and wish to
request special consideration of these items.
A. Student Information
B#
Last Name First Name M.I. Student ID
B. Required Documentation
The chart below shows which documentation must be submitted to demonstrate special circumstances. If for any
reason the required documentation is not available, include a written explanation of why it is not available.
Loss of Income
1. Typed, signed letter explaining the change in circumstances. Include when the
change occurred and your family’s current financial situation.
2. Letter of termination.
3. Unemployment determination letter.
4. Final paystub.
5. Signed copy of 2018 Form 1040 filed with the IRS or 2018 IRS Tax Transcript for
both you and your parent, if not already submitted during the verification
process.
6. Signed copy of 2019 Form 1040 filed with the IRS or 2019 IRS Tax Transcript for
both you and your parent.
7. If this form is filed after January 1, 2021, signed copies of your and your
parent’s 2020 income tax return(s) must be attached.
Reduction of Income
1. Typed, signed letter explaining the change in circumstances. Include when the
change occurred and your family’s current financial situation.
2. All current paystubs.
3. Signed copy of 2018 Form 1040 filed with the IRS or 2018 IRS Tax Transcript for
both you and your parent, if not already submitted during the verification
process.
4. Signed copy of 2019 Form 1040 filed with the IRS or 2019 IRS Tax Transcript for
both you and your parent.
5. If this form is filed after January 1, 2021, signed copies of your and your
parent’s 2020 income tax return(s) must be attached.
EFSC Office of Financial Aid
www.easternflorida.edu/go/aid | (321) 433-7339 | finaid@easternflorida.edu
2
Parent’s Change in
Marital Status
1. Typed, signed letter explaining the change in circumstances. Include when the
change occurred and your family’s current financial situation.
2. Divorce decree or separation agreement.
3. Child support or alimony agreement.
4. All current paystubs.
5. Signed copy of 2018 Form 1040 filed with the IRS or 2018 IRS Tax Transcript for
both you and your parent, if not already submitted during the verification
process.
6. Signed copy of 2019 Form 1040 filed with the IRS or 2019 IRS Tax Transcript for
both you and your parent.
7. All W-2s for 2018 and 2019 if your parents a filed joint return.
8. If this form is filed after January 1, 2021, signed copies of your parents’ 2020
income tax return(s) must be attached.
Excessive Medical
Expenses – Exceeds 11%
of your income. Cannot
include charges covered
by insurance.
1. Typed, signed letter explaining the change in circumstances. Include when the
change occurred and your family’s current financial situation.
2. Documentation of medical expenses.
3. Signed copy of 2018 Form 1040 filed with the IRS or 2018 IRS Tax Transcript for
both you and your parent, if not already submitted during the verification
process.
4. Signed copy of 2019 Form 1040 filed with the IRS or 2019 IRS Tax Transcript for
both you and your parent.
5. If this form is filed after January 1, 2021, signed copies of your and your
parent’s 2020 income tax return(s) must be attached.
Death of Parent
1. Typed, signed letter explaining the change in circumstances. Include when the
change occurred and your family’s current financial situation.
2. Signed copy of 2018 Form 1040 filed with the IRS or 2018 IRS Tax Transcript for
both you and your parent, if not already submitted during the verification
process.
3. Signed copy of 2019 Form 1040 filed with the IRS or 2019 IRS Tax Transcript for
both you and your parent.
4. Death certificate.
5. Documentation regarding any proceeds you or your family have received or
expect to receive from your parent’s estate, including inheritance, insurance,
pensions, Social Security, etc.
6. If this form is filed after January 1, 2021, signed copies of your and your
parent’s 2020 income tax return(s) must be attached.
Loss of Untaxed Income
1. Typed, signed letter explaining the change in circumstances. Include when the
change occurred and your family’s current financial situation.
2. Official documentation terminating the untaxed income.
3. Signed copy of 2018 Form 1040 filed with the IRS or 2018 IRS Tax Transcript for
both you and your parent, if not already submitted during the verification
process.
4. Signed copy of 2019 Form 1040 filed with the IRS or 2019 IRS Tax Transcript for
both you and your parent.
5. If this form is filed after January 1, 2021, signed copies of your and your
parent’s 2020 income tax return(s) must be attached.
EFSC Office of Financial Aid
www.easternflorida.edu/go/aid | (321) 433-7339 | finaid@easternflorida.edu
3
One Time Income –
Inheritance, lottery
income, IRA or pension
distribution, moving
expenses allowance
1. Typed, signed letter explaining the change in circumstances. Include when the
change occurred and your family’s current financial situation.
2. Corresponding documentation.
3. Signed copy of 2018 Form 1040 filed with the IRS or 2018 IRS Tax Transcript for
both you and your parent, if not already submitted during the verification
process.
4. Signed copy of 2019 Form 1040 filed with the IRS or 2019 IRS Tax Transcript for
both you and your parent.
5. If this form is filed after January 1, 2021, signed copies of your and your
parent’s 2020 income tax return(s) must be attached.
Other – Please explain
1. Typed, signed letter explaining the change in circumstances. Include when the
change occurred and your family’s current financial situation.
2. Corresponding documentation.
3. Signed copy of 2018 Form 1040 filed with the IRS or 2018 IRS Tax Transcript for
both you and your parent, if not already submitted during the verification
process.
4. Signed copy of 2019 Form 1040 filed with the IRS or 2019 IRS Tax Transcript for
both you and your parent.
5. If this form is filed after January 1, 2021, signed copies of your and your
parent’s 2020 income tax return(s) must be attached.
C. Estimated Income for 2020
Type of Income
Student
Parent 1
Income from Work (wages, salary, tips, severance pay, etc.)
Other Taxable Income (unemployment, pension etc.)
Untaxed Social Security Benefits
Child Support/Alimony Received
In kind support from family or friends (someone paying bills
in your name)
TOTAL
➢ Please Note: If this form is filed after January 1, 2021, signed copies of your and your parent’s 2020 income
tax return(s) must be attached.
EFSC Office of Financial Aid
www.easternflorida.edu/go/aid | (321) 433-7339 | finaid@easternflorida.edu
4
D. Household Information
List below the people in your parent’s household. Include:
• Yourself.
• Your parent(s) (including a stepparent) even if you do not live with your parent(s).
• Your parent’s other children if your parent(s) will provide more than half of the children’s support from July
1, 2020, through June 30, 2021 or if the other children would be required to provide parental information if
they were completing a FAFSA for 2020-21. Include children who meet either of these standards, even if the
child does not live with your parents.
• Other people if they now live with your parent(s) and your parent(s) provide more than half of the other
person’s support and will continue to provide more than half of that person’s support through June 30,
2021.
Full Name
Age
Relationship
College
(Enter only if household member will
be attending at least ½ time)
Will be
Enrolled at
Least ½ Time
Self
Eastern Florida State College
Yes
E. Certification and Signature
By signing below I certify that all of the information reported is
complete and correct.
Student’s Signature (cannot be signed electronically) Date
Parent’s Signature (cannot be signed electronically) Date
WARNING: If you purposely give false
or misleading information, you may be
fined, sent to prison, or both.
EFSC Office of Financial Aid
www.easternflorida.edu/go/aid | (321) 433-7339 | finaid@easternflorida.edu
5
F. Document Submission
You may submit this document by the following methods:
1. EFSC DOCUMENT DROPBOX (RECOMMENDED)
Print and complete this document (including the original signatures), scan the document, and upload the
document via the Document Dropbox in myEFSC.
2. BY MAIL
Mail your document to the Office of Financial Aid at:
Eastern Florida State College
Office of Financial Aid
Building 2, Room 209
1519 Clearlake Road
Cocoa, FL 32922
QUESTIONS?
Financial Aid Specialists are available by phone at 321-433-7339 and via e-mail at finaid@easternflorida.edu.
Eastern Florida State College is committed to equal access/equal opportunity in its programs, activities, and employment. For
additional information, visit Eastern Florida State College: easternflorida.edu/go/equity.
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2020-21 Special Circumstances Appeal Dependent Student (Eastern Florida State College)

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Completed 21 July 2020

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