2024-2025 Special Circumstances Independent Student
Financial Aid Office | 309.341.5283 | finaid@sandburg.edu
Student Name
*
First Name
Last Name
Student ID#
*
Last 4 Digits of Student SSN xxx-xx-
*
Student Email
*
Please indicate if any of the following pertains to your circumstances:
Loss of employment or decrease in income for student and/or spouse?
Yes
No
Please explain when the change of employment or decrease in income occurred, for whom and why. If you and/or your spouse have obtained new employment, please indicate the date started, average hours, and wage rate. If you worked any temporary jobs, share the amount earned and provide documentation.
Provide a copy of your (and spouse if married) most recent federal income tax returns (1040). Include schedules 1, 2 and 3 and W-2 forms.
Upload requested documents here:
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Back
Next
Student or spouse received unemployment benefits in 2022, 2023, 2024 or 2025?
Yes.
No
The FAFSA allows us to remove income when a student or spouse received unemployment benefits. Please explain who received unemployment benefits and the applicable dates.
Provide the statement of unemployment benefits.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Back
Next
Change in Child Support Benefits?
Yes
No
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.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Back
Next
A One-Time, Non-Recurring Income received in 2022?
Yes
No
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 your 2022 taxes.
Provide a signed copy of the student (and spouse's if married) 2022 Federal Income Tax Return, W-2 forms and Schedule 1.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Back
Next
Private K-12 School Tuition Paid?
Yes
No
Provide a statement showing the amount of tuition you paid for members of your household.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Back
Next
Payment for Spouse's Federal Student Loans?
Yes
No
Please provide a statement showing the amount of payments made on a yearly basis for educational debt between the years 2021 and 2024. The statement should show amounts by year. Make sure to include the monthly payment amount, date payments started and when they will end.
Please provide a payment history, cancelled checks, or receipts to verify the amounts paid.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Back
Next
Separation or Divorced AFTER submitting the 2024-25 FAFSA?
Yes
No
Please provide a copy of the divorce decree or legal separation agreement OR written explanation.
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.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Back
Next
Do You Support Multiple Households?
Yes
No
If the income reported on the FAFSA is required to support multiple households such as situations where married family members live apart, elder care, or care of family outside the US, please provide a detailed explanation including dates, reason for living apart, expenses paid, etc.
Please provide documentation of multiple addresses and living costs for both households.
Please provide documentation of elder care expenses, including paid receipts.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Back
Next
Funeral Expenses or Unreimbursed Medical Expenses?
Yes
No
Medical expenses that exceed 11% 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 you paid funeral expenses, please provide documentation of the amount paid, for whom and the relationship to you.
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 (2021), Medicaland Dental Expenses | Internal Revenue Service (irs.gov)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Back
Next
Death of Spouse AFTER submitting the 2024-25 FAFSA?
Yes
No
Please provide a copy of the Death Certificate and a signed copy of the 2022 Federal Income Tax Return and W-2 forms.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Back
Next
Rollover of Pension in 2022?
Yes
No
If your 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.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Back
Next
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.
Back
Next
Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: