One App Special Circumstance Form

Special Circumstance Form
If you feel the FAFSA does not provide an accurate or complete picture of your family’s financial situation, please complete this form to explain and document your personal, special circumstance(s). Students with a Student Aid Index (SAI) of $30,000 or higher are encouraged to submit this form. We are happy to consider these circumstances and invite you to share this information with us.
Student's Name*

First NameLast Name
Student's Email*
example@example.com
Student's Date of Birth*

MonthDayYear
Person completing this form:*

StudentParentOther (explain relation to the student)
Special Circumstance(s): Check all boxes that apply to your situation.*

Loss of employment or reduction in pay/hoursLoss of benefitsSeparation or divorce of parentsDeath of parentOne-time (lump sum) payment receivedMedical expensesUnusual expensesMultiple family members in collegeSmall business/farm owner whose business assets were included on FAFSAStudent is independently paying for collegeOther circumstances not covered above
Explanation of Circumstances: Please use the space below to provide a detailed explanation of why you believe the information on your FAFSA does not accurately reflect your current financial situation.*
Please list the names of any household members currently attending college or university at least half-time (6+ credit hours), and enrolled in a degree or certificate program.

Supporting Documentation

Please upload any supporting documentation to the student's application in the Questa student portal. The list below includes examples of acceptable documentation. While submitting supporting documents is optional, providing them will help us better understand your current financial situation.

This list is also available at www.questafoundation.org/traditional-scholars-application-guide.

Special Circumstance	Recommended Supporting Documents
Loss of employment	Copy of last/most recent paystub with YTD earnings Letter from previous employer stating date of termination or reduction in pay and/or hours Severance statement (if applicable)
Loss of benefits	Last check stub(s) or printout of benefit(s) received Letter from agency verifying date and amount of benefit(s) lost.
Separation or divorce of parents	Documentation of separation, divorce, or verification of separate residences Documentation of child support, family support, or maintenance support. Include support that is received or anticipated to be received.
Death of parent	Copy of Death Certificate and/or Obituary
One-time (lump sum) payment received	Clarification (ie. IRA distribution, sale of property, inheritance, 1099 form, etc). Detailed explanation of how income was used
Medical expenses	Explanation of situation and estimate of out of pocket medical expenses paid Estimate of future out of pocket medical expenses
Unusual expenses	Description of circumstances related to expense Copy of receipts, statements (if applicable)
Student is independently paying for college	Letter from a trusted adult (not a parent) who can verify the student is not receiving financial help from their family to pay for college

I certify that the information provided on this Special Circumstances Form is accurate and complete as of the signature date. I understand that submitting this request does not guarantee that I/the student will be awarded funding.
Signature of person completing form: *

Clear
Signature Date

MonthDayYear
Should be Empty: