/ For Office Use Only:
Professional Judgment Request
Due to Special Circumstances
2016-2017 / Verified: c Yes c No
Verif. Done?: c Yes c No
EFC =

*NOTIFY THE CASHIERS OFFICE: if you have an unpaid tuition balance and are awaiting the results of this request!*

IMPORTANT: This form may only be submitted on or after October 1, 2016.
Note: Students must be admitted into a Financial Aid eligible program before submitting this form.
Requests will NOT be reviewed if your current EFC (Expected Family Contribution) is 100 or lower.

If you feel that your Free Application for Federal Student Aid (FAFSA) does not reflect an accurate financial picture, you may submit this request to review the data elements of your FAFSA. If your 2016 income will be significantly lower than 2015, this review could result in an adjustment to your financial aid eligibility. Resulting adjustments will be retroactive, but no earlier than the start of the Fall 2016-2017 semester, if applicable.

Examples of special circumstances include: a reduction in income or benefits, unusually high medical and dental expenses paid out of pocket, dislocated worker status, or unusual circumstances not covered in the financial aid application.

Examples of ineligible circumstances are: car payments, credit card debt, medical insurance premiums, mortgages or rent, Chapter 7 personal bankruptcy, home equity loans, and parents that will not help pay college costs. We cannot make adjustments for these circumstances.

Last Name First Name M.I. / NTC Student ID
Address (include apt. no.) / Email address
( )
City State ZIP Code / Phone Number (include area code)

You must complete Parts I and II of this form before your request will be reviewed. We are required by federal regulation to collect documentation before adjusting data elements on your FAFSA.

PART I: Please indicate which of the following situations have resulted in your Special Circumstance request AND attach requested documentation.

1)  STUDENT (SELF)

Change in income? If Yes, check applicable circumstance below. If No, then go to #2.

ð  Became unemployed?

Effective Date: ______Name of Employer and Hire Date: ______

*Attach letter of termination from employer (if available) AND most recent unemployment statement.

ð  Wages reduced?

Effective Date: ______Name of Employer and Hire Date: ______

*Attach most recent pay stub.

2)  SPOUSE (if married)

Change in income? If Yes, check applicable circumstance below. If No, then go to #3.

ð  Became unemployed?

Effective Date: ______Name of Employer and Hire Date: ______

*Attach letter of termination from employer (if available) AND most recent unemployment statement.

ð  Wages reduced?

Effective Date: ______Name of Employer and Hire Date: ______

*Attach most recent pay stub.

~Please complete Page 2 on reverse~

Student Name ______ID # ______

3)  MOTHER (if Dependent student for FAFSA purposes)

Change in income? If Yes, check applicable circumstance below. If No, then go to #4.

ð  Became unemployed?

Effective Date: ______Name of Employer and Hire Date: ______

*Attach letter of termination from employer (if available) AND most recent unemployment statement.

ð  Wages reduced?

Effective Date: ______Name of Employer and Hire Date: ______

*Attach most recent pay stub.

4)  FATHER (if Dependent student for FAFSA purposes)

Change in income? If Yes, check applicable circumstance below. If No, then go to #5.

ð  Became unemployed?

Effective Date: ______Name of Employer and Hire Date: ______

*Attach letter of termination from employer (if available) AND most recent unemployment statement.

ð  Wages reduced?

Effective Date: ______Name of Employer and Hire Date: ______

*Attach most recent pay stub.

5)  DIVORCE or SEPARATION (Attach YOUR 2015 W-2 forms if this situation applies.)

-Date that divorce or separation occurred: ______

-Number of children: _____

-Number of children that YOU will claim on your 2016 tax return: _____

-Between 7/1/2016 and 6/30/2017, will you…

ð  Receive child support?

*Attach documentation.

ð  Pay child support?

*Attach documentation.

-Between 7/1/2016 and 6/30/2017, will you…

ð  Receive maintenance/spousal support (alimony)?

*Attach documentation.

ð  Pay maintenance/spousal support (alimony)?

*Attach documentation.

6)  WORKER’S COMPENSATION

*Attach annual benefit statement for 2015 for any of the above individuals if applicable.

PART II: Please type and attach a self-written/signed letter explaining the above circumstances. Include as much detail as possible, including dates, figures, etc. so that we have an accurate understanding of how your financial situation has changed and what it will be between 7/1/2016 and 6/30/2017. To view an example of a completed form and letter, please go to www.ntc.edu>Current Students>Financial Aid>Financial Aid Forms>2016-2017 Financial Aid Forms and look for Sample Special Circumstance Form 2016-2017.

I certify that the information provided on this form and accompanying documentation is true and correct to the best of my knowledge and belief. I understand that underestimating projected income, or giving false or misleading information, could result in reduced eligibility, repayment of aid, or both in the current or next academic year. I further understand that I am required to notify the Financial Aid Office if I receive additional income or resources.

Student Signature (Required) Date / MAIL / RETURN TO:
Northcentral Technical College
Financial Aid Office
1000 W Campus Drive
Wausau WI 54401-1899 / FFF FAX TO:
715.301.2904
Parent Signature (Required if Dependent Student) Date / Attn: Financial Aid
Please Include: Student Name & NTC Student ID #
Spouse Signature (Required if Married) Date

Requests are typically reviewed within 3 – 4 weeks. Depending on your circumstances and current eligibility, the review may or may not warrant a change in your overall financial aid package. The Financial Aid Office will notify you of the results with an email to your NTC student email account.