Student Name ______

OfficeofFinancial Aid

2016-2017Request for Professional Judgment

Follow the steps below and return this form with the appropriate documentation to the Hiwassee College Office of Financial Aid. The information you provide on this form will be reviewed to determine if adjustments to your FAFSA can be made. Please allow 2-3 weeks processing time (Processing time may be 3-4 weeks during July to September). You will be notified once your request has been reviewed and the decision will be sent to your Hiwassee College email address. All decisions made by the Office of Financial Aid concerning income adjustments are final. If you have questions, please contact the Office of Financial Aid at (423) 420-1244.

To complete your appeal, you must:

Attach a detailed and signed letter from the student to this Appeal Form documenting the special circumstances.

From the list provided, indicate the reason for the requested review of your family’s financial situation and provide indicated documentation.

Change in Marital Status

  • Copy of legal separation documentation, proof of separate households, divorce decree, death certificate or marriage certificate, depending on circumstance
  • Copy of 2015 W-2’s
  • In case of marriage, please attach both individual’s 2015 Federal IRS Tax Return Transcript.

(The IRS Tax Return Transcript can be requested by calling 1-800-908-9946 or on-line at

Involuntary Loss of Job, or Involuntary Parental Loss or Reduction of Employment

  • Letter(s) from applicable former employer(s) stating the last date of employment (Separation Notice)
  • Copy(s) of applicable last pay stub(s) from former employer(s) and current employer(s) if applicable
  • Copy of unemployment compensation letter from the state or signed statement that did not and will not receive unemployment
  • Copy(s) of 2015 W-2’s

Loss of Benefits (Social Security Benefits, Child Support, Worker’s Compensation, Alimony, Unemployment Benefits, etc.)

  • Copy of benefit termination notice and amount of benefits received in 2016
  • Copy of divorce decree indicating the last date of child support

Other Loss/ Reduction of Income- May include but not limited to: loss/reduction of Income due to natural disaster or large sum of medical bills paid out of pocket in 2015.

  • Copy of 2015 Schedule A or consolidated statements of medical expenses paid out of pocket in 2015 from each medical provider (doctor, hospital, pharmacy)- Explanation of benefits (EOB) statements are not acceptable if appealing medical bills that were paid out of pocket.
  • Documentation verifying loss if appealing for natural disaster

Estimated Income for 2016

Please list each employer in the calendar year 2016 for person(s) with income loss/reduction.

  • A copy of the last check stub(s) for ALL employment this current year must be submitted for person(s) with income loss or reduction. Check here if additional space is needed and a separate sheet is attached–be sure to include student ID.

Name of person / Employment information / Actual Earning YTD (1/1/2016- today) / Estimated income (today – 12/31/2016) / Total
Employer:______
Employed From: ______To:______
Employer:______
Employed From: ______To:______

Estimated 2016 income from ALL other sources for person(s) with income loss or reduction. Be sure to put a zero if any of the items do not apply to you.

Amount Received 1/1/2016- today / Amount received per month/week / Select One / Estimated total for 2016
Unemployment Compensation / Per Month or PerWeek
Untaxed IRA Distributions / Per Month or PerWeek
Child Support Received / Per Month or PerWeek
Veteran’s non-education benefits (disability, etc.) / Per Month or PerWeek
Severance Pay / Per Month or PerWeek
Alimony Received / Per Month or PerWeek
Pension or Annuity / Per Month or PerWeek
Other income(Disability, etc.) / Per Month or PerWeek

By signing this form, I certify that all of the information reported on it is complete and correct. I agree to provide proof of the information if and/or when requested. I understand that the penalty for providing false or misleading information is a $20,000 fine, a prison sentence, or both.

______

Student’s SignatureDate Student’s Phone Number

______

Parent’s Signature (if dependent)Date Parent’s Daytime Phone Number