University of Wisconsin - Stevens Point

Financial Aid

2009-2010 Unusual Circumstance Form

Your 2008 tax returns and 2009-2010 FAFSA must be completed prior to submitting a UCF. Be sure to keep all narratives within the left and right margins of the space provided; you may scroll downward as far as is needed.

* Denotes a required field.

Student Identification

Name of person completing this form:
*E-mail address of person completing this form:
Daytime phone number of person completing this form:
Your (student's) Name:
Your (student's) Birthdate: (MM/DD/YYYY)
Your (student's) ID Number:
Student's E-mail address:

1. SPECIAL EXPENSE SITUATION

(check only if appropriate):

Substantial elementary or high school education tuition expected 6/01/2009 - 5/31/2010
Amount to be paid:	$
Who creates this expense:	Brother Sister Your Child
Name of sibling(s)/child(ren) school:

Substantial medical/dental expenses expected 6/01/2009 - 5/31/2010:
Amount you will pay (out-of-pocket) yourself (not covered by insurance):	$
Who pays this expense?	Parent Student
Describe illness (keep content within left and right within margins):


Amount to pay for parent(s) tuition attending college/university 6/01/09 - 5/31/10 (out-of-pocket, not covered by financial aid and/or employer reimbursement): $
Name of parent's college or university:

Unless there is also an income loss, you may skip Section 2.

2. LOSS OF INCOME SITUATION

Who has suffered a loss of income?	Father Mother Student Spouse
What is the unusual circumstance?
Wage earner is ill:	Dates of illness:
	from: to:
Describe illness:


Wage earner has died:	Date of death:

Family member has lost or will lose benefits:
What benefit is affected?
Date benefits terminated:

Wage earner has lost job:
When was last day of work?
Has new job been found?	YesNo
Yes - start date:
Income has been reduced for other reason
When did reduction take effect?

Reason for reduction:


Family member divorced or separated since FAFSA filed
Date of divorce or separation:

Dependent student only - with which parent will you now live (show only this parent's income below)?
MotherFather
If you have siblings, who will they live with?
MotherFather
Child support that will be received?	$

INCOME INFORMATION FOR CALENDAR YEAR

Provide expected 2009 gross income for all applicable family members; January 1 - December 31, 2009

	Father	Mother	Student	Spouse

2009 wage income:	$	$	$	$
2009 other taxable income:	$	$	$	$
2009 untaxed income:	$	$	$	$

Note about the following information request:
When a family income loss occurs late in the academic year, it may be determined that the income estimate should be based upon a twelve-month period that more closely approximates the academic year calendar. Please determine family income for the period specified below and estimate this information as carefully as possible. According to your circumstance, we will choose which income information should be the basis for your analysis of need.

INCOME INFORMATION FOR AWARD YEAR

Provide expected gross income for the 2009-2010 award year for all applicable family members; 6/01/2009 - 5/31/2010

	Father	Mother	Student	Spouse

2009-2010 wage income:	$	$	$	$
2009-2010 other taxable income:	$	$	$	$
2009-2010 untaxed income:	$	$	$	$

3. CERTIFICATION

Transmission of data by student under personal password represents that all data submitted is authorized as stated. Parental data may not be submitted unless authorized by student's parent. The Financial Aid office may corroborate data submitted through telephone contact with parents.

This section may be omitted if student is classified as an independent student, but it must be completed if student is a dependent student.

Parent(s) contact information:

Father's Name:	Phone:
Mother's Name:	Phone:

4. Additional Narrative: Provide any additional narrative that you feel will help us understand your situation.

5. Transmit Information:

If all information entered above is accurate (and any parental information is authorized by parent), you may transmit it to the Financial Aid office at UW-Stevens Point at this time. You may expect to be notified of any action taken within a few weeks.

Financial Aid

2009-2010 Unusual Circumstance Form

Unless there is also an income loss, you may skip Section 2.

Parent(s) contact information: