Athens, Georgia 30602-6114 Fax ... - University of Georgia · Special Circumstances Request -...
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Special Circumstances Request - Income Loss/Changes or Excessive Medical Expenses Form PJ216 Created: March 5, 2020 Page 1 of 1 Return Completed Form To: Office of Student Financial Aid 220 Holmes/Hunter Academic Building Athens, Georgia 30602-6114 Fax: (706) 542-8217 Student's UGA ID 81 Student's Telephone Number Student's Full Name POLICY: Federal regulations allow limited exceptions or adjustments to information reported on the Free Application for Federal Student Aid (FAFSA). Such exceptions or adjustments, known as "Special Circumstances" or "Professional Judgment," are considered on an annual case by case basis based on supporting documentation of the situation and available income/assets. Whether any adjustments are made is at the sole discretion of the Office of Student Financial Aid (OSFA), and cannot be appealed beyond OSFA. PROCEDURE: This form is an "in-take" form for OSFA to screen your Special Circumstances request for the academic year (do not submit supporting documentation at this time). OSFA will respond to this request within 5 business days. If this request is permissible, you will be notified to submit supporting documentation through the OSFA Secure Portal. Special Circumstance processing can take up to 2 weeks once all supporting documentation is received (note that during peak processing times [i.e., June through September] processing can take up to 4 weeks). DIRECTIONS: 1 Complete this form by selecting the Special Circumstances type(s) below and signing/dating the form 2 Attach a student signed/dated statement detailing the Special Circumstances (include your UGA Student ID [81XXXXXXX]) 3 Submit form and student signed/dated statement to OSFA By submitting this request, I acknowledge that I will comply timely with requests from UGA's Office of Student Financial Aid (OSFA) for additional supporting documentation. I further acknowledge the review of and final decision on my request is solely at the discretion of OSFA, and cannot be appealed beyond OSFA. If approved, I further acknowledge OSFA staff will transmit changes to my FAFSA to the federal processor. I attest and certify that the information provided in this request (including any written statements, additional information, and/or supporting documentation) are a true, complete, and accurate representation of my circumstances. I acknowledge that purposely providing false or misleading information on this form, or in any supporting documentation or information provided by me or on my behalf, may subject me to university sanction, loss of student financial aid, and/or criminal penalty and/or fine(s). Date Student's Signature Income Loss/Changes l Income Loss/Changes Special Circumstances that can be considered: loss of employment; changes to household income (either taxed, untaxed, reoccurring, or one-time/lump sum income); divorce, separation, death of household income-earner, etc. l Income Loss/Changes Special Circumstances that cannot be considered: credit card debt; car payments; mortgage payments; existing student (or parent) loan debt; other forms of consumer debt l Student Signed Statement must include the following: detailed and dated description of the income loss/change and how information on the 2020-21 FAFSA is not accurate representation of currently available income/assets l Future Supporting Documentation Requests may include: Federal Tax-Transcript/Returns; W-2s; final paystubs; official termination/separation letters; official divorce/separation agreement or death certificate l Excessive Medical Expense Special Circumstances that can be considered: excessive out of pocket medical expenses that exceed 11% of the tax-filer's adjusted gross income (AGI) l Excessive Medical Expense Special Circumstances that cannot be considered: medical expenses paid by insurance or others l Student Signed Statement must include the following: detailed and dated description of the medical situation and the dates/amounts of medical expenses paid out of pocket l Future Supporting Documentation Requests may include: only Explanation of Benefits statement (EOBs) from insurance providers detailing out of pocket expenses will be accepted Excessive Medical Expenses
Transcript of Athens, Georgia 30602-6114 Fax ... - University of Georgia · Special Circumstances Request -...
Special Circumstances Request - Income Loss/Changes or Excessive Medical Expenses
Form PJ216
Created: March 5, 2020Page 1 of 1
Return Completed Form To:Office of Student Financial Aid 220 Holmes/Hunter Academic Building Athens, Georgia 30602-6114 Fax: (706) 542-8217
Student's UGA ID
81
Student's Telephone Number
Student's Full Name
POLICY: Federal regulations allow limited exceptions or adjustments to information reported on the Free Application for Federal Student Aid (FAFSA). Such exceptions or adjustments, known as "Special Circumstances" or "Professional Judgment," are considered on an annual case by case basis based on supporting documentation of the situation and available income/assets. Whether any adjustments are made is at the sole discretion of the Office of Student Financial Aid (OSFA), and cannot be appealed beyond OSFA. PROCEDURE: This form is an "in-take" form for OSFA to screen your Special Circumstances request for the academic year (do not submit supporting documentation at this time). OSFA will respond to this request within 5 business days. If this request is permissible, you will be notified to submit supporting documentation through the OSFA Secure Portal. Special Circumstance processing can take up to 2 weeks once all supporting documentation is received (note that during peak processing times [i.e., June through September] processing can take up to 4 weeks).
DIRECTIONS: 1 Complete this form by selecting the Special Circumstances type(s) below and signing/dating the form 2 Attach a student signed/dated statement detailing the Special Circumstances (include your UGA Student ID [81XXXXXXX]) 3 Submit form and student signed/dated statement to OSFA
By submitting this request, I acknowledge that I will comply timely with requests from UGA's Office of Student Financial Aid (OSFA) for additional supporting documentation. I further acknowledge the review of and final decision on my request is solely at the discretion of OSFA, and cannot be appealed beyond OSFA. If approved, I further acknowledge OSFA staff will transmit changes to my FAFSA to the federal processor. I attest and certify that the information provided in this request (including any written statements, additional information, and/or supporting documentation) are a true, complete, and accurate representation of my circumstances. I acknowledge that purposely providing false or misleading information on this form, or in any supporting documentation or information provided by me or on my behalf, may subject me to university sanction, loss of student financial aid, and/or criminal penalty and/or fine(s).
DateStudent's Signature
Income Loss/Changes l Income Loss/Changes Special Circumstances that can be considered: loss of employment; changes to household income (either taxed, untaxed, reoccurring, or one-time/lump sum income); divorce, separation, death of household income-earner, etc. l Income Loss/Changes Special Circumstances that cannot be considered: credit card debt; car payments; mortgage payments; existing student (or parent) loan debt; other forms of consumer debt l Student Signed Statement must include the following: detailed and dated description of the income loss/change and how information on the 2020-21 FAFSA is not accurate representation of currently available income/assets l Future Supporting Documentation Requests may include: Federal Tax-Transcript/Returns; W-2s; final paystubs; official termination/separation letters; official divorce/separation agreement or death certificate
l Excessive Medical Expense Special Circumstances that can be considered: excessive out of pocket medical expenses that exceed 11% of the tax-filer's adjusted gross income (AGI) l Excessive Medical Expense Special Circumstances that cannot be considered: medical expenses paid by insurance or others l Student Signed Statement must include the following: detailed and dated description of the medical situation and the dates/amounts of medical expenses paid out of pocket l Future Supporting Documentation Requests may include: only Explanation of Benefits statement (EOBs) from insurance providers detailing out of pocket expenses will be accepted
Excessive Medical Expenses
