2024-2025 Special Circumstances Dependent Student

2024-2025 Special Circumstances Form Dependent Student

Financial Aid Office | 309.341.5283 | finaid@sandburg.edu
Student's Name*

First NameLast Name
Student ID#*
Student Email*
example@example.com
Parent's Name*

First NameLast Name
Parent Email (cannot be same email as student)*
example@example.com
I am completing this form as the:

Student Section

Please complete the student information and STOP at the red line and submit the form. This form will automatically be emailed to your parent's email address and they will complete, sign and submit the final form.
Last 4 Digits of Student SSN xxx-xx-*

Was there loss of employment or decrease of income for the student?*

YesNo
Please explain when the change of employment or decrease of income occurred, for whom and why. If student have obtained new employment, please indicate the date started, average hours, and wage rate. If student worked any temporary jobs, share the amount earned and provide documentation.
- Provide a copy of student's federal income tax return from 2023. Include schedules 1, 2 and 3 and W-2 forms.
- Provide most recent paystub(s) from all jobs worked in 2024 for student.
- Provide any documentation of unemployment income received in 2023 or 2024.
- After January 1, 2025: Provide most recent paystub(s) from all jobs worked in 2025 for student.
Upload documentation here:*

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Student received a one-time, non-recurring income received in 2022?*

YesNo
Provide an explanation of the one-time income reported on the 2022 tax return. Examples may be: withdrawal of retirement income; moving allowances; inheritance; lottery winnings; or other non-recurring income that shows on student's 2022 taxes.
Provide a signed copy of the student's 2022 Federal Income Tax Return, W-2 forms and Schedule 1.

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Student Signature*

Clear
End of Student Section. The following information is to be completed by the parent after the student has submitted the form.

Parent Section

Please complete the required information below. Make sure to sign and submit after you have completed the form.
Please indicate if any of the following pertains to your circumstances:
Loss of employment or decrease of income for parent or stepparent?

YesNo
Please explain when the change of employment or decrease of income occurred, for whom and why. If parent/stepparent have obtained new employment, please indicate the date started, average hours, and wage rate. If parent/stepparent worked any temporary jobs, share the amount earned and provide documentation.
- Provide a copy of parent/stepparent 2023 federal income tax return(s). Include schedules 1, 2 and 3 and W-2 forms.
- Provide most recent paystub(s) from all jobs worked in 2024 for parent/stepparent.
- Provide any documentation of unemployment income received in 2023 or 2024.
- After January 1, 2025: Provide most recent paystub(s) from all jobs worked in 2025 for parent/stepparent.
Upload documentation here:*

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Was there a reduction in child support benefits received since 2022?

YesNo
Please explain when and why the change occurred:
Provide documentation of the child support change. This could be a statement from the Child Support Enforcement Agency, a bank statement or court document.

Cancelof

Was there a one-time, non-recurring income received in 2022?

YesNo
Provide an explanation of the one-time income reported on the 2022 tax return. Examples may be: withdrawal of retirement income; moving allowances; inheritance; lottery winnings; or other non-recurring income that shows on student, parent/stepparent 2022 taxes.
Provide a signed copy of the parent/stepparent 2022 Federal Income Tax Return, W-2 forms and Schedule 1.

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Separation or divorce AFTER submitting the 2024-25 FAFSA?

YesNo
- Please provide a copy of the divorce decree or legal separation agreement OR written explanation.
- Please provide documentation showing different addresses if separated (examples: lease agreements; utility bills)
- Please provide proof of child support received or paid.
- Please provide a signed copy of the 2022 Federal Income Tax Return and W-2 forms.
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K-12 school tuition paid?

YesNo
Provide a statement showing the amount of tuition you paid for members of your household.

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Funeral expenses or unreimbursed medical expenses?

YesNo
Medical expenses that exceed a percentage of the adjusted gross income reported on the FAFSA can be excluded from income. Please provide an explanation of the medical expenses, date occurred and payment arrangements. If funeral expenses were paid, please provide documentation of the amount paid, for whom and the relationship to the parent.
Please provide copies of medical expenses PAID out-of-pocket that will not be reimbursed by insurance, and proof of payment. (Medical expenses include the premiums you pay for insurance that covers the expenses of medical care, and the amounts you pay for transportation to get medical care. Medical expenses also include amounts paid for qualified long-term care services and limited amounts paid for any qualified long-term care insurance contract following IRS Publication 502 (2022), Medical and Dental Expenses | Internal Revenue Service (irs.gov)

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Death of a parent/stepparent AFTER submitting the 2024-25 FAFSA?

YesNo
Please provide a copy of the death certificate and a signed copy of the 2022 Federal Income Tax Return and W-2 forms.

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Rollover of IRA/pension distribution in 2022?

YesNo
If parent/stepparent 2022 Federal Income Tax Return included an IRA or Pension distribution and the amount was a rollover to another qualified retirement plan, the amount can be excluded as income on your FAFSA. Indicate the amount which was rolled over into another qualified retirement plan:
Please provide a copy of the 2022 IRS Form 1099-R for documentation.

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Anything else we should consider?
Use this section to provide any additional information regarding your appeal. Please be as specific as possible and include important details as to what changed, and dates the changes occurred.

2024-2025 Special Circumstances Form Dependent Student