ࡱ> rtqe <bjbjhh |Dii,\c|CCCCCbbbbbbb givbi888bCCGcppp8 CCbp8bpp0]PbC;B"_6b]c0cJ_5jd5jlPb5jPbxLj6p,lbbF*c88885jY m:  PAINE COLLEGE Office of Financial Aid Telephone: 706-822-8262 1-800-476-7703 1235 Fifteenth Street Augusta, GA 30901-3182 Fax: 706-822-8691 2024-2025 SPECIAL CIRCUMSTANCE APPEAL A Special Circumstance Appeal allows the student/parent to inform the Financial Aid Office of a decrease in income due to loss of job, benefits, death, separation or divorce from what was reported on the Free Application for Federal Student Aid (FAFSA) or unusual medical/dental expenses not covered by insurance. Be advised that the Financial Aid Office is simply reviewing your special circumstance appeal and that your appeal may be denied. Failure to provide any information requested will result in an automatic denial. A decision letter will be mailed to you no later than fourteen days from the date the completed request is received by the Financial Aid Office, including all required documentation. The decision of the С Financial Aid Office is FINAL and cannot be appealed to the U.S. Department of Education. PLEASE PRINT THE FOLLOWING INFORMATION: Name: _________________________________ ID #: _________________ Local Address: _________________________________ SSN: _________________ _________________________________ Telephone #: ____________________ PART 1: Check the type of special circumstance(s) that apply to your situation. Each circumstance lists acceptable documentation for you to submit to the Financial Aid Office. Include a brief explanation of your circumstance. % Separation from work due to Layoff or Involuntary Termination for a minimum of ten (10) weeks in 2024 (separation must have already occurred) Letter from employer (on company letterhead) documenting separation from employment (must include last day worked) Unemployment Benefits determination document Submit year to date documentation of 2024 income (i.e., last pay stub) Submit documentation of severance pay Complete Part 2 % Marital Separation, Pending Divorce or Divorce (parties must reside in separate residences) after filing FAFSA Copy of Divorce Decree or legal documentation verifying marital separation Total net worth of liquid assets to be received for 2024 Documentation of Alimony to be received for 2024 Documentation of Child Support to be received in 2024 Complete Part 2 (excluding spouse or non-custodial parent) % Death of a Parent or Spouse after filing FAFSA Copy of Death certificate Complete Part 2 including income of surviving parent % Loss of Benefits (benefits received in 2024 and terminated in 2024) Documentation of expected 2024 benefits Documentation of termination of Social Security benefits due to child turning 18 Documentation of termination of Child Support % Medical or Dental Expense Paid in 2024 not covered by Insurance in excess of 5% of Adjusted Gross Income Submit a listing of paid out-of-pocket expenses with supporting documentation Expenses can include doctors visits, tests, outpatient care, therapy, prescription drugs, hospitalization, vision care, dental and/or orthodontic Documentation must clearly verify insurance coverage CONTINUED PART 2 Statement of Estimated Income for 2024 (Annual not monthly amounts) Project your income earned from work from January 1, 2024, through December 31, 2024 (attach current or last pay stub for each job included in your projected income). Project any other income and benefits from January 1, 2024, through December 31, 2024 (attach documentation to support amounts reported). STUDENTSPOUSEFATHERMOTHERProjected Income from Work$$$$Dates of EmploymentFrom ToFrom ToFrom ToFrom ToName of Employer(s) Other Projected Income* ]_`ft   F G N S o p v  ھھڶynyffbfbbfbbfbhHhHCJaJhH5>*CJaJhH5CJaJ"h5hH56CJOJQJaJ"h5hV56CJOJQJaJhOJQJhOJQJhHOJQJhCJOJQJ^JaJh wCJOJQJ^JaJhHCJOJQJ^JaJhHCJOJQJaJhHCJOJQJaJ&t  F G o p   I K ^`^ `^``0]0$a$gdgd$a$ 0^`0 &dP  ' I J K R S ^`bd&.f $.NMN489t`b:<>R筭ҭ筭ҭ筭h wCJOJQJaJhCJOJQJaJhHCJOJQJaJh5CJOJQJaJhHCJOJQJaJhHCJaJhH5CJOJQJaJhH5CJOJQJaJhHCJaJhH6fNN9tb\%&^ & F & F & F^ & F 8h^8`h & FRFHJ \%&0123456789:ABdheij̸̫̓h wCJOJQJaJh_^CJOJQJaJhHCJOJQJaJhH5CJOJQJaJhHCJaJhCJOJQJaJhHCJOJQJaJhH5CJOJQJaJh5CJOJQJaJh`\Y5CJOJQJaJ5&0123456789: $$Ifa$8^8^^$a$  #&+.36;>?STUVWXYqrstuvw888 9 9 9#9999:>:V:X:]:达hCJOJQJaJhHCJOJQJaJhHCJOJQJaJhH56CJOJQJaJhH56CJOJQJaJhCJOJQJaJUhH5CJOJQJaJhHCJOJQJaJhHCJOJQJaJ6kd$$Iflr&e!|)?1  t20644 lap2  Ekd($$Iflr&e!|)?1 t0644 la$If#&+.36;>$If>?STUVWXKEEEEEE$Ifkd$$Iflr&e!|)?1 t0644 laXYqrstuvKEEEEEE$Ifkd$$Iflr&e!|)?1 t0644 lavw 9 9 9#999KEEEEEE^kd;$$Iflr&e!|)?1 t0644 la*Other income can include, but is not limited to Workers Compensation, pension/annuities, unemployment benefits, Social Security Benefits, child support/alimony, retirement/disability benefits, and welfare benefits (excluding food stamps or subsidized housing). Certification Statement I hereby certify that all information contained in this appeal is true and complete to the best of my knowledge. I have not knowingly or intentionally provided any fraudulent documentation. _________________________________________________________________________________________ Student Signature Date _______________________________________________________________________________________________________________ Spouse Signature Date _______________________________________________________________________________________________________________ Mothers Signature Date _______________________________________________________________________________________________________________ Fathers Signature Date FOR OFFICE USE ONLY**** APPROVED ______ DENIED ______ REVIEWED BY _______________________ DATE ____________ COMMENT(S): 99>::::::;;;;<<<<.</<<-$$d%d&d'dNOPQ^a$gd*$d%d&d'dNOPQ^gd^]:^::::::];v;x;};~;;<< <<<<<.</<[<r<<<<<<<<<<<<<<<˿׷hOJQJhCJOJQJaJhHCJOJQJaJhHOJQJhH5OJQJhCJOJQJaJhHCJOJQJaJ%<<<<<<<<<<<<<<*$d%d&d'dNOPQ^gd z+p,p-p.p1h/R 4567:p/ =!"#h$% &$$If!vh#v#v#v?#v1#v:V l  t206555?515ap2$$If!vh#v#v#v?#v1#v:V l t06555?515a$$If!vh#v#v#v?#v1#v:V l t06555?515a$$If!vh#v#v#v?#v1#v:V l t06555?515a$$If!vh#v#v#v?#v1#v:V l t06555?515ax2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@66666_HmH nH sH tH @`@ NormalCJ_HaJmH sH tH DA D Default Paragraph FontVi@V  Table Normal :V 44 la (k (No List HH  Balloon TextCJOJQJ^JaJDBD Body Text$a$CJOJQJ^JNP@N Body Text 2$a$56CJOJQJaJPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V (BO)MBT.$@0H!A>풠Uc-zD[&!rX=}zC0` ި%.]Ssd--7 +fOZեrŵVœ\lji2ZGwm-3˵j7\ Uk5FҨ-:xRkcr3Ϣ+9kji9OP Et-j|#p;E=Ɖ5Z2sgF=8 K}*7c<`*HJTcB<{Jc]\ Ҡk=ti"MGfIw&9ql> $>HmPd{(6%z:"'/f7w0qBcF6f Iöi1(\}B5ҹ~Bcr6I;}mY/lIz1!) ac 1fm ƪN^I77yrJ'd$s<{uC>== Ƌ(uX=WA NC2>GK<(C,ݖm: &-8j^N܀ݑ$4:/x vTu>*ٞn{M.Ǿ0v4<1>&ⶏVn.B>1CḑOk!#;Ҍ}$pQ˙y')fY?u \$/1d8*ZI$G#d\,{uk<$:lWV j^ZơSc*+ESa1똀 k3Ģxzjv3,jZU3@jWu;z \v5i?{8&==ϘNX1?  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