Financial Aid Special Consideration Form 2020-2021
Name
Last First MI
Emplid Phone Number
(
)
This Special Consideration Form may be used by you and your family to report unusual circumstances not addressed on
the Free Application for Financial Federal Student Aid (FAFSA) that you believe affect y
our ability to contribute to your
education at Reynolds Community College. These circumstances may be conditions that negatively impacted your 2019
finances when compared to the 2018 income reported on the 2020-2021 FAFSA or adversely affect your current income
due to extraordinary expenses. Before the Financial Aid Office can review the information on this form, you must
have previously filed a 2020-2021 FAFSA and completed the verification process if you were selected and
previously awarded.
The information provided on your original application may not be updated if your income reduction is not significant or
appears inconsistent. Likewise, expenses for consumer goods and lifestyle choices may not be supported with additional
financial aid resources.
Please complete all of the required information appropriate to your circumstances. It is your responsibility to provide all
requested documentation. Incomplete forms and forms without the appropriate documentation will not be
processed. Reviews are done on a case-by-case basis. All decisions are final.
1. Please check the reason for your special consideration request and attach the required documentation.
Please note the Financial Aid Office reserves the right to request additional documentation, if needed.
A. Unusual medical and/or dental expenses that were incurred during the tax year provided on the
FAFSA. Documentation needed: Copy of 2018 IRS Tax Return transcript and associated Schedule A
and/or medical receipts and Explanation of Benefits forms.
B. Death, divorce, or separation has occurred since the FAFSA was filed. Documentation needed: Copy of
death certificate or divorce/separation decree, copy of 2018 IRS Tax Return Transcript, and 2018 W-2(s
).
C. Loss of unemployment compensation. Documentation needed: Letter from unemployment office stating
start/end dates and benefit amount, and 2018 IRS Tax Return Transcript.
D. Loss of child support. Documentation needed: Letter or court document stating start/end dates and child
support amount.
E. Loss of Worker’s Compensation benefits. Documentation needed: Letter from Bureau of Worker’s
Compensation stating start/end dates and benefit amount.
F. Loss of income parent and/or student (spouse, if applicable) from work due to layoff, closing of
business, termination, or reduction in employment hours to attend school. Documentation needed:
A copy of the 2018 AND 2019 IRS Tax Return Transcript from the IRS including all schedules and
W2 statements for these tax years.
Letter from previous employer documenting effective dates and severance, vacation, personal and
sick leave pay out.
Copy of final pay stub from previous job.
Letter from unemployment office documenting effective dates and benefits received.
Copy of most recent pay stub from current job, if applicable
Doc
umentation of any other income received during the calendar year
2. Please explain in detail the reason(s) for your request for special consideration and the details of your
income reduction or unusual medical/dental expenses. Provide an additional sheet if necessary.
3. Please provide the amount that you and your family expect to receive between January 1, 2020 and
December 31, 2020. If your parent is divorced, separated, or widowed, don’t include information about
the other parent. If you are divorced, separated, or widowed, don’t include information about your
spouse.
Income Source Amount
Income Earned from Work Last paycheck stub, W-’s, tax returns, letter from employer
$
Other Taxable Income
dividends, interest, pensions, alimony, annuities, 401k,
severance package, etc.
$
Child Support Letter from child support enforcement, court order $
Other Untaxed Income Letter from agency providing resources (TANF, Worker’s
Compensation, Social Security Benefits)
$
Unemployment benefits Virginia Employment Commission statement $
Certification Statement: I (we) certify that the information provided on this form is
complete and accurate to the best of
my (our) knowledge. If I (we) provide false or misleading information, I (we) understand that I may be fined $20,000, sent
to prison, or both. I (we) understand that should the circumstance(s) identified in this form change due to subsequent
employment and/or receipt of monies not available at the time of submission of this form, I (we) will notify the Office of
Financial Aid immediately of these changes.
A parent’s signature is only necessary when you were required to provide information about them on your 2020-2021 Free
Application for Federal Student Aid (FAFSA).
Student Signature Date
Parent Signature
Date
Office of Financial Aid
Post Office Box 85622
Richmond, VA 23285-5622
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