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Document Sample
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University of California, Berkeley

Financial Aid Parent Contribution Appeal

Deadlines: This appeal must be submitted by February 1, 2010. If you are enrolled for

2009-2010

the fall semester only, this appeal must be submitted by October 1, 2009.

• Please use black ink (no fine point) and make sure all documentation is legible.

• Include the student's name and social security number on each page of documentation.

• All documentation must be on 8 1/2 x 11 inch paper.



Student name:______________________________________________________________________________

Soc. Sec. #: __________________________________ Student I.D.# __________________________________

Student E-mail:_______________________________ Parent E-mail: ________________________________

Student Phone: _______________________________ Parent Phone: ________________________________



Instructions If there has been a change in family financial circumstances from 2008 to the present, which is beyond

your (the parents') control and you wish to appeal the parent contribution, you must provide:



• A letter of explanation describing, in detail, the circumstances of your appeal.

• Copies of all appropriate documentation specifically pertaining to your circumstance.

• A complete copy of your (the parents') 2008 Federal Income Tax Return with all W2s and schedules (if not

already submitted).

• This form with page 2 completed and signed by the parent.

• Additional information that applies to your specific situation.

The following are circumstances that may be considered:



1. INCOME REDUCTION

a. Provide copy of employment termination letter, including verification of severance pay or retirement benefits or

explain why you do not have one of the above documents.

b. Provide copy of unemployment benefits (if not provided, we will assume $450 per week for one year).

c. Provide copy of disability benefits eligibility.

d. Provide copy of termination notice of other income (e.g., Social Security).

e. Provide copy of year-to-date earnings (copy of last paycheck stub).

f. If you are self employed, provide copies of your prior year and current year profit and loss statements.

g. Provide copy of divorce/separation agreement.



2. DEATH OF A PARENT

a. Provide copy of death certificate,

b. Provide documentation of death benefits and insurance payments.



3. UNUSUAL AND NECESSARY EXPENSES

a. Medical emergencies: provide statement from insurance provider stipulating amount of medical expenses not covered

by insurance.

b. Tax liens: provide statement from Internal Revenue Service and /or State Franchise Tax Board indicating monthly

payment amount on back taxes owed prior to 2008.



Important: Any changes to financial aid awards will be contingent on the type of funds available, eligibility

policies and regulations.

Office Use Only

Counselor/Date:

Comments:







Forms; ParentContributionAppeal53-0910; ldp-3/12/09

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PARENTS' EXPECTED INCOME

Date of Income Change: _________________ (month/day/year). Report income that you, the parent(s),

received and/or expect to receive for the 12-month period following the date that your income changed.



Monthly One-Time End Date

Income Source Amount Payment (Provide documentation)





TAXABLE INCOME

Income earned from work by father: __________ __________ ________________

Income earned from work by mother: __________ __________ ________________

Severance pay: __________ __________ ________________

Retirement benefits: __________ __________ ________________

Social Security Benefits (SSB): __________ __________ ________________

Unemployment benefits: __________ __________ ________________

Business/farm income: __________ __________ ________________

Rental property: __________ __________ ________________

Alimony: __________ __________ ________________

Other taxable Income (specify):

__________________________________ __________ __________ ________________

NON TAXABLE INCOME

TANF/AFDC: __________ __________ ________________

Social Security Benefits (SSB): __________ __________ ________________

Workers Compensation/Disability: __________ __________ ________________

Child Support: __________ __________ ________________

Other untaxed income (specify):

__________________________________ __________ __________ ________________

OTHER NON TAXABLE INCOME

(Not reported on FAFSA)

Supplemental Security Income (SSI): __________ __________ ________________

Money received or paid on your behalf : __________ __________ ________________





I certify that all the information on this form is true and complete and I will report any changes in writing to the Financial Aid

and Scholarships Office.



Parent Signature_________________________________________ Date _______________________



Reminders:

• Did you provide a letter of explanation regarding your appeal?

• Did you provide all appropriate documentation in support of your appeal?

• Did you provide a copy of your 2008 Federal Income Tax Return?

• Did you sign and date this form?

To expedite the processing of this form, you may fax it to our Financial Aid Forms Fax: 510-643-2015

University of California, Berkeley, Financial Aid and Scholarships Office, 211 Sproul Hall, Berkeley, CA 94720-1960



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