Special Conditions Appeal Form

Typical Reasons for Appeal

My family has experienced a loss of employment and/or reduction in wages since 2024.My family has experienced loss of a benefit(s) since 2024.My family supports people not living in our household (parent, grandparent, older sibling, extended family).My family has multiple children enrolled in college or private K-12 schools.My family has out-of-pocket medical expenses totaling over 11% of the Adjusted Gross Income (AGI) within a 12-month period.More than one of the above applies to me.None of these applies to me.

Which of the Following Applies?

Dependent Student (parent information is included on FAFSA).Independent Student (no parent information is included on FAFSA).

Please confirm the following details for EACH parent currently working in the household...
1) Employer and current year to date and project earnings for the remainder of the calendar year.
2) If this parent had the loss of employment, please indicate the final date of employment and details regarding any benefit package or severance pay provided. If this parent has projected employment, indicate their expected date of hire and projected earnings.
3) Please indicate any additional income earning revenue (i.e., rental income, business net income).

Please confirm the following details. If you are married, please provide the same details for your spouse...
1) Please indicate employer and current year to date and projected earnings for the remainder of the calendar year.
2) If there was a loss of employment, please indicate the final date of employment and details regarding any benefit package or severance pay provided. If there is a projected employment scenario, indicate expected date of hire and projected earnings.
3) Please indicate any additional income earning revenue (i.e., rental income, business net income).

Please indicate the loss of benefit and dollar amount that equates to this loss of benefit.

Can you please indicate the number of people that are currently living in your household? For anyone who does not live in your household, but you are financially supporting, please provide the dollar amount of financial support you provide in a 12-month period.

Please provide information about the medical expenses incurred (including the date the expense was incurred and if reoccurring, how often the expense is incurred). Please provide an estimate of out of pocket medical expenses that were incurred in the previous 12-month period, or year to date and projected medical expenses for the current 12-month period.

Can you please elaborate on your reasons for appeal?

Can you please elaborate on your reason to appeal?

Special Conditions Appeal Form

Parent/Guardian/Other Contact Information