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Request for Review of Financial Aid Application 2005-2006 by add15613


									                                                   Request for Review of Financial Aid Application 2009-10
                                                                           Lord Fairfax Community College
                                                                                      Financial Aid Office
                                                                                     173 Skirmisher Lane
                                                                                    Middletown, VA 22645
                                          Phone: 540-868-7130                      Fax: 540-868-7274                       E-mail
Section A: Student Identification [Please Print]

Last Name                         First Name                                             M.I.                                   Student I.D#

Section B: Special Circumstances

Please check the box or boxes that apply. These circumstances generally will warrant a review and possibly an adjustment of the federally calculated
“expected family contribution.”

Income Decrease (if due to resignation or termination, a copy of the letter of termination or last date of employment letter on company letterhead must be
          A parent’s income will be lower in 2009 than it was in 2008 because (please describe briefly):

           A student’s/spouse’s income will be lower in 2009 than it was in 2008 because (please describe briefly):
Educational or Non-Discretionary Expenses

            A parent of a financially dependent student (generally, a student who is 23 or younger) will be enrolled in college at least half-time and working
            toward a degree or certificate in 2009-10 as a condition of employment or in response to a family financial emergency. (If the parent is
            reimbursed for tuition there is no basis or appeal.)

            A family is paying extraordinary non-discretionary expenses in 2009 (please describe briefly):

Change in Marital Status
         The parents of a financially dependent student have separated/divorced since the 2009-10 Free Application for Federal Student Aid (FAFSA) was
            submitted.        Date of Separation/Divorce ______________
         A financially independent student and her spouse have separated/divorced since the 2009-10 FAFSA was submitted.
                              Date of Separation/Divorce ______________

Section C: Suggested Supporting Documentation
             We can analyze your situation and respond to your request for an aid adjustment if you submit a clear explanation and reasonable
             documentation of your circumstances.
                Submit this form with a typewritten or legibly handwritten narrative that explains the nature of the event or situation,
                the date or time period in which it occurred and the financial impact in total dollars that you have experienced or
                expect to experience in 2009.
                Required Documentation: Signed copies of most recent Federal tax return, W-2s, and Independent or Dependent
                Verification Worksheet (available at
             We offer the following suggestions for supporting documentation (please provide legible photocopies):
Income Loss or Decrease:                                                       Parent Enrolled in College
         Loss or decrease in wages: paycheck stubs before                                  Verification of College Enrollment form
             and after the event, notice of termination by employer,                        Copy of paid tuition bill
             notice of retirement benefits, last date of employment            Extraordinary Non-Discretionary Expenses:
             letter (all notices must be on employer letterhead)               The bill, statement or insurance claim which verifies the amount of out-
         Job resignation or termination : final paystub and                   of-pocket expenses the family incurs for the following conditions:
             copy of termination letter or letter from employer with                        Medical or dental expenses
             last date of employment on company letterhead must                             Home repairs required because of natural or man-made
             be provided                                                                       disaster or necessary maintenance (examples: roof or
         Decrease in business income: business income                                         furnace replacements)
             statement and balance sheet for 2008 and 2009                                  Bankruptcy filing petition
         Termination of Social Security benefits: notice                                   Other (please describe)
             from the Social Security Administration                                           ________________________________
         Non-recurring capital gain: IRS Form 1040,                                           ________________________________
             Schedule D                                                                        ________________________________
         Reimbursement of moving expenses: itemized list
             of payments from your employer, IRS Form 4782, or                 Change in Marital Status:
             both                                                                           Petition for divorce or legal separation
         Other

Section D: Certification
I/we affirm that the information contained in this form, in the narrative description and in all supporting documentation is true and complete to the best of
my/our knowledge. Per the Department of Education, if you purposely give false or misleading information, you may be fined up to
$20,000, sent to prison, or both.
    Student and/or parent’s job loss/termination letter or last date of employment letter is attached OR                         Employer refused
request to provide (must explain to us why the requested letter will not be provided).

Student’s Signature                                                                                        Date

Parent’s Signature                                                                                         Date

Student’s Spouse’s Signature                                                                               Date

Section E: Action Taken                           [Do not complete. Office Use Only]
Appeal          Granted   Not Granted
Justification: ________________________________________________________________________________
_______________________________________________________________Emailed? Y N New EFC___________
Signature ____________________________________________________               Date _______/_______/_______

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