INDEPENDENT STUDENT 2017-2018 REQUEST FOR CONSIDERATION OF SPECIAL CIRCUMSTANCES - Part 1 - Instructions and Required Documentation

Sep 19, 2026

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Request form for independent students to appeal or request review of financial aid for 2017-2018 due to special circumstances. The document lists required submission materials, including a detailed special-circumstances letter, a completed verification worksheet (V6), 2015 IRS federal tax return transcript and 2015 W-2s, plus case-specific evidence. It defines eligible circumstance categories such as medical expenses, involuntary income reduction, loss of non-taxable benefits, divorce/separation, spouse death, one-time taxable earnings, and private school tuition, then provides the 2017 income projection section and signature/attestation language.

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INDEPENDENT STUDENT 2017-2018 REQUEST FOR CONSIDERATION OF SPECIAL CIRCUMSTANCES

Required documentation checklist

Special circumstance categories and evidence required

Expected income and untaxed income totals

Attestation and submission notes

IRS Tax Return Transcript Request Process

Telephone request steps

Financial Aid Office W3718 South Drive Plymouth, WI 53073 Fax: 920-565-1070 INDEPENDENT STUDENT 2017-2018 REQUEST FOR CONSIDERATION OF SPECIAL CIRCUMSTANCES Student Name: Social Security or LU Student ID \# Daytime Phone: ( ) - You have requested that we review your financial aid application due to special circumstances. Please submit the following documentation to our office: 1) Letter detailing your special circumstances; 2) Completed 2017-2018 Verification Worksheet (V6) (attached); 3) 2015 IRS Federal Tax Return Transcript for you (and your spouse, if applicable) . This form may be requested directly from the IRS. Instructions on how to request the Federal Tax Return Transcript are attached. 4) 2015 W-2’s for student (and spouse, if applicable); 5) Information/documents requested for the specific special circumstances you checked below. Please attach and return all documents to the Financial Aid Office as soon as possible. We must have your 2017-2018 Free Application for Federal Student Aid (FAFSA) on file before you appeal. PLEASE INDICATE BELOW THE SPECIAL CIRCUMSTANCE THAT APPLIES TO YOUR SITUATION: 1. Unusual or excessive medical expenses, not covered by insurance, incurred and paid in 2015. Documentation Required: • Schedule A of 1040 Federal tax form OR • Copies of cancelled checks or statements showing amount paid (please total all items) 2. Involuntary reduction in student or spouse employment income for at least 10 weeks in 2017. As a general rule, the projected 2016 Adjusted Gross Income (AGI) should be at least 20% less than the actual 2015 AGI before submitting documentation. Documentation Required: • Complete reverse side of this form • Last pay stub for the person with the involuntary reduction of income • Statement from previous employer indicating last day of employment • If receiving unemployment compensation, a copy of your benefits determination ● If receiving severance pay, a copy of documentation of pay 3. Complete loss of non-taxable income, such as Child Support, Worker’s Compensation, TANF, AFDC and Veteran’s Benefits, for at least 10 weeks in 2017. Documentation Required: • Written statement from appropriate agency showing loss of benefit and termination date 4. You and your spouse, have become legally separated or divorced after submission of your original FAFSA. Documentation Required: • Copy of legal divorce decree or separation order • Date of separation/divorce: / / ● A copy of your 2015 Federal Tax Return 5. Your spouse has died after the submission of your original FAFSA. Documentation Required: • Copy of death certificate ● A copy of your 2015 Federal Tax Return 6. A typical one-time taxable earning such as a capital gain, 401K disbursement or moving expenses reflected on 2015 Federal income taxes. Documentation Required: • Statement indicating nature of earnings and proof as to what the funds were used for 7. Tuition expenses at a private elementary or secondary school incurred and paid in 2015. Documentation Required: • Copy of paid tuition statements • Letter from school(s) • Cancelled checks (please total checks) EXPECTED 2016 INCOME (January 1, 2017 – December 31, 2018) If you checked section 2 on the front of this form please complete this income section and include documentation supporting your amounts. Otherwise, skip this section and sign and date the form below. STUDENT’S 2016 INCOME (if married, include spouse’s income) Taxable Income: Student’s Income from Work $ Spouse’s Income from Work $ Unemployment Compensation $ Business, Farm or Rental Income $ Dividends, Interest, Capital Gains, etc. $ Any Other Taxable Income (itemized) $ TOTAL Projected 2017 Taxable Income $ Untaxed Income: Untaxed Portions of IRA Distributions or Pensions $ Child Support $ Veterans Noneducation Benefits $ Retirement Plan Contributions (401K,

FAQs

What materials must be submitted to request consideration of special circumstances for 2017-2018 aid?

Submit a letter describing special circumstances, the completed 2017-2018 Verification Worksheet (V6), a 2015 IRS Federal Tax Return Transcript, 2015 W-2s, and any documents required for the specific special circumstance selected.

Which special circumstances are covered and what evidence is required for each?

The form covers unusual/excessive medical expenses, involuntary reduction in income for at least 10 weeks in 2017, loss of non-taxable income for at least 10 weeks in 2017, divorce/separation after the original FAFSA, spouse death after the original FAFSA, one-time taxable earnings, and private elementary/secondary school tuition—each with specified supporting documentation.

How does the form require IRS Tax Return Transcript requests to be handled?

It recommends using the IRS Data Retrieval Tool via a FAFSA correction when possible. It also explains requesting a Federal Tax Return Transcript free from the IRS, with the telephone method described as the preferred option, including calling 1-800-908-9946 and selecting the option to request a 2015 transcript.

Sep 19, 2026

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