Box 70580  Johnson City, TN 37614-1708  Fax: (423)439-2070

Associate Dean (423)439-2019 Financial Services (423)439-2035

Admissions and Records (423)439-2033 Student Support Services (423)439-2037

Request for Professional Judgment

In accordance with federal regulations pertaining to educational student loans, the Qullen College of Medicine establishes an annual standard educational budget for all students based on expected tuition, fees, books, supplies, housing, etc. The Quillen College of Medicine may take into account extenuating circumstances to make adjustments to a student’s educational budget, as determined by federal guidelines. Adjustments must be reasonable and documented. Specific documentation is required for each situation. Listed below are the base guidelines for professional judgments. Students requesting consideration for adjustments should complete and sign this form, attach required documentation and deliver/mail or email to the Quillen College of Medicine, Office of Financial Aid. Incomplete forms or documentation will not be processed. Access to federal regulations pertaining to professional judgments can be found at

Dependent Care Allowance: Child care for dependent children under the age of 18 may be

allowable if provided by and HRS-approved child care center, and agency-approved au pair, or

anon-HRS approved child care provider who is not an immediate family member. Students

mustprovide a copy of a statement from child care provider to include beginning date of

childcare, amount to be charged per week less any deductions for holiday or sick days.

Excessive Medical/Dental Expenses: Medical or dental expenses not covered by

insurancemay be considered. Students must provide documentation for out of pocket expenses

andreceipts of payments. Additional documentation may be requested if necessary.

Vehicle Expenses: Tire replacement (maximum lifetime allowance) and other vehicle

repairsthat may be needed in addition to regular normal vehicle maintenance may be

taken into consideration. Documentation such as invoice for tires/repairs with date of

purchase/repair and receipt of payment for vehicle services. Vehicle identification number (VIN)

should also be on the invoice.

Technology Allowance: All entering medical students are required to have a personal laptop

computer appropriately configured to be compatible with the QCOM classroom internet network,

ETSU facilities, and Desire2Learn (D2L) on the web. Students may find it necessary to

purchase a handheld device. Total approval amount for a laptop purchase is $1,500, total

approval amount for a handheld device is $500. Students needing to purchase any technology

equipment may have the cost included in their educational budget for student financial aid

purposes. Proper documentation to include detailed sales invoice with date of purchase and

receipt of payment to be provided to the QCOM Office of Financial Aid. Date of

purchase/payment must fall within the student’s educational budget for the academic school

year.

By signing this form, you are requesting consideration for adjustment to your educational budget.

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Student Signature Date Banner ID