Financial Aid Office ● 197 Franklin St. • Auburn, NY  13021

   315-255-1743 ext. 2470 • Fax 315-252-2185


 

2014-2015 FINANCIAL AID APPEAL FOR LOSS OF INCOME AND/OR BENEFITS


_____________________________________________________________________________________________

Student’s Printed Name                                                                                        Cayuga ID #

 

The Financial Aid Office of Cayuga Community College realizes that students and their families may experience an unforeseen loss of income and/or benefits during an academic year.  This form is designed to address your possible need for additional funding as a result of a loss of income or benefits.   

 

Instructions:

Ø  In order to be considered for any federal professional judgment all students must complete a federal aid application (FAFSA) and complete the federal verification process.

Ø  All students are required to complete the 2014-2015 Household Size and Number in College Form.

Ø  Students (and Spouse) are required to submit a copy of their 2013 IRS Tax Transcript or 2013 Non-Tax Filer statement along with copies of their 2013 W-2 Forms.

Ø  Parents of dependent students are required to submit a copy of their 2013 IRS Tax Transcript or 2013 Non-Tax Filer Statement along with copies of their 2013 W-2 Forms.

Ø  Depending on the reason for your appeal, you are required to submit the supporting documentation listed under each reason for your appeal.

Ø  Voluntary termination of employment will not be considered for an appeal.

 

Certification Statement:

The information provided on this form is true and complete to the best of my knowledge.    I have submitted a copy of the documents listed above and any other supporting documentation requested on this form.

 

___________________________________________________________         ______________________

Student Signature                                                                                                     Date

 

 

Parent Printed Name

___________________________________________________________         ______________________

Parent Signature (if applicable)                                                                                         Date

 

 

Office Use Only:       Appeal Approved _________             Appeal  Denied ________      

ActionTaken:____________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

FA Counselor :__________________________________________________Date:__________________

 
 

 

 

 

 

 

 


Complete Information on Reverse Side

Financial Aid Appeal -  Loss of Income and/or Benefits

 

Please check below the appeal conditions that best meets your conditions:

 

1.       _____  Loss of Employment

Name of person whose employment has ceased:______________________________________________

Person’s relationship to student: __________________________________________________________

Date of employment was ceased:___________________________________________________________

Document Required:

·         Letter confirming involuntary termination of your employment and date employment ceased.

·         Verification documents listed on reverse side of this form.

 

2.       _____Loss of Benefits

Name of person losing the benefit:  ________________________________________________________

Person’s relationship to student: __________________________________________________________

Type of benefit that will be lost in either 2014 or 2015 ________________________________________________

Date the benefit was lost: ________________________________________________________________

How much of the benefit was lost:__________________________________________________________

Documentation Required:

·         A copy of a letter from the agency that provided benefits, detailing termination of benefits and copies of summaries of benefits received in 2013.

·         Verification documents listed on reverse side of this form.

 

3.       ­­_____Retirement

Name of person retiring: ________________________________________________________________

Person’s Relationship to Student___________________________________________________________

Date Retirement becomes Effective:________________________________________________________

Documentation required:

·         Copy from employer stating the date of your retirement

·         Statement  from employer if severance pay was awarded and how much was granted

·         Verification documents listed on reverse side of this form.

 

4.       _____Loss of Income Due to Separation or Divorce

If Dependent Student

Name of custodial parent: ________________________________________________________________

Date of separation or divorce:_____________________________________________________________

What is the monthly amount of financial support that the custodial parent will receive for living expenses from the non-custodial parent?_______________________________

What is the monthly amount of child support that will be paid to the custodial parent? ______________

Documentation Required:

·         Proof of separate address from non-custodial parent

·         Verification documents listed on reverse side of this form.

If Independent Student

Name of spouse :________________________________________________________________________

Date of separation or divorce:_____________________________________________________________

What is the monthly amount of financial support that the student will receive from his/her separated or divorced spouse? ________________________

What is the monthly amount of child support you will receive?__________________________________

Documentation Required:

·         Proof of separate address from separated or divorced parent.

·         Verification documents listed on reverse side of this form.