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Use Ira Mortgage Payment Unemployed

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Use Ira Mortgage Payment Unemployed Powered By Docstoc
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     Name (please print)                                                                      Social Security Number


                          REQUEST for SPECIAL CONSIDERATION BASED on REDUCED INCOME
                                               2010-2011 Academic Year

     Dear Student:

     You have indicated to us that your family income for 2010 will be reduced compared to your 2009 family income. In order for
     us to evaluate this situation and update your application to use your Projected 2010 family income, you must fill out the back
     of this form in its entirety. Where projected income is requested, please estimate as accurately as possible since you may be
     required to verify the information at the end of 2010. If you get federal student aid based on incorrect information, you will
     have to pay it back. You may also have to pay fines and fees.

A.      ( ) Death of Spouse (death must have occurred ON OR AFTER January 1, 2009).

                     Date: _____/_____/_____ (Month/Day/Year)               _______________________ (Relationship)

B.      ( ) Permanent and total (unable to work again) disability of Spouse (must have occurred
                ON OR AFTER January 1, 2009).

                     Date: _____/_____/_____ (Month/Day/Year)               _______________________ (Relationship)

C.      ( ) Student has retired; been unemployed for at least two full months or has experienced a change in
                 employment status which will result in an income reduction ON OR AFTER January 1, 2009.

                     Date: _____/_____/_____(Month/Day/Year)

D.      ( ) Spouse has retired; been unemployed for at least two full months or has experienced a change in
                 employment status which will result in an income reduction ON OR AFTER January 1, 2009.

                     Date: _____/_____/_____ (Month/Day/Year)

E.      ( ) Untaxed income has ceased or been reduced.                      Date: _____/_____/_____ (Month/Day/Year)


F.      Please provide a detailed explanation for the circumstance surrounding the reduction in your 2010 family income.




                                                 PLEASE COMPLETE REVERSE SIDE

     GWYNEDD-MERCY COLLEGE                                                                   Student Financial Aid Office
                                                                                              REDINC - IND 2010-2011
        Gwynedd Valley, PA 19437-0901                                                           (215) 646-7300 Extension 595
G.        Complete both of the sections (Gross Taxed and Untaxed) below with income (prior to exemptions, adjustments, or
          deductions) your family expects to receive from January 1, 2010 until December 31, 2010. Social Security benefits and
          railroad retirement benefits are considered untaxed income for purposes of this form and should be included in Section H.
          IF NONE, ENTER ZEROS. ROUND TO NEAREST DOLLAR. DO NOT SHOW CENTS.

        TOTAL 2010 GROSS TAXED INCOME
                                                                           Student’s                         Spouse’s
                                                                           Yearly Income                     Yearly Income

       1. Wages, Salaries, Tips                                       $                                  $
       2. Severance Pay                                               $                                  $
       3. Pension, annuities and/or IRA distributions                 $                                  $
       4. Interest and dividend income                                $                                  $
       5. Business or farm income                                     $                                  $
       6. Capital gains                                               $                                  $
       7. Income received from rents after expenses paid for          $                                  $
          Mortgage interest, taxes, and insurance
       8. Alimony which will be received                              $                                  $
       9. Unemployment Compensation                                   $                                  $
      10. Any other taxed income                                      $                                  $

          Total 2010 Gross Taxed Income                               $                                  $

H.      TOTAL 2010 UNTAXED INCOME
                                                                           Student’s                         Spouse’s
                                                                           Yearly Income                     Yearly Income

       1. Any contributions to tax-deferred pension and savings        $                                 $
          plans (paid directly or withheld from earnings). Include
          untaxed portion of 401(k) and 403(b) plans.
       2. Social Security benefits (SSI or disability) received by the $                                 $
          parents plus the benefits received for the student and other
          children.
       3. Retirement or Disability Benefits                            $                                 $
       4. Worker’s Compensation                                        $                                 $
       5. Welfare benefits, including TANF (excluding food             $                                 $
          stamps or subsidized housing)
       6. Untaxed portion of pensions                                  $                                 $
       7. Housing, food, and other living allowances for clergy,       $                                 $
          military, and others (include cash payments or cash value
          of benefits).
       8. Child support or maintenance payments which will be          $                                 $
          received for the student and ALL OTHER FAMILY
          MEMBERS (include cash support of money paid on
          family’s behalf from a non-custodial parent; include
          assistance with college expenses, payment of bills such as
          mortgage/rent, car payments, living expenses, etc.; (exclude
          foster care or adoption payments).
       9. Veteran’s noneducation benefits, and VA educational          $                                 $
          work-study allowances
      10. Railroad retirement benefits                                 $                                 $
      11. Earned Income Credit                                         $                                 $
      12. Any other untaxed income and benefits such as Black Lung $                                     $
         Benefits, Refugee Assistance, untaxable combat pat, etc.

          Total 2010 Untaxed Income                                   $                                  $

Warning: If you purposefully give false or misleading information on this worksheet, you may be fined, imprisoned, or both.

                                                                                                REDINC - IND 2010-2011
______________________________   __________   ______________________________          __________
Signature of Student             Date          Signature of Spouse                    Date




                                                             REDINC - IND 2010-2011

				
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