STUDENTS NAME: ____________________________ SOCIAL SECURITY NUMBER: ____________________

The Financial Aid Office at Danville Area Community College requires that you write a brief paragraph explaining why you feel your situation warrants a reevaluation of your information for Federal Student Assistance Programs. You must also supply supporting documentation to your claim and complete this application thoroughly.

Write a statement and attach it to this form, explaining the circumstances of your situation.  You must give dates to substantiate your information as well as return the proper forms that are related to your situation.  You will be required to furnish your 2005 tax forms, verification documents, and this form (be sure to complete the back of this form).

Estimate your resources as accurately as possible to avoid the need to correct information back to the original base-year income eligibility.  A reversal of the Special Conditions may result in you (the student) owing money back to the financial aid programs. You will be required to submit your 2007 federal tax return after filing.

DOCUMENTATION NEEDED  (Depending on Circumstance indicated):
___A.  Involuntary Unemployment or change in employment
1.  2006 Tax return- 1040/1040A/1040EZ and Income worksheet
2.  Name, address, telephone number of former employer
3.  Reason for loss of employment
4.  Check stub showing earnings to date
5.  Verification of unemployment - and unemployment compensation (or fact not eligible for compensation)
6.  Verification of disability and benefit (if applicable)

___B.  Death of a spouse or parent
1.  Copy of death certificate
2.  How income for 2007 will be affected
3.  Benefits to be received in 2007 (including insurance and/or “lump” sums)
4.  2006 1040/1040A/1040EZ
5.  Copy of all  W2's reported on 2006 tax return

___C.  Divorce or separation of student or parent
1.  Copy of separation or divorce decree (or statement from a lawyer) showing date of separation or divorce.
2.  Income to be received for 2006 (child support, alimony, etc.)
3.  2006 1040/1040A/1040EZ

___D.  Unusual medical and dental expenses your family has paid (must be above 11% Income allowance)
1.  Document any medical or dental bills not paid by insurance in 2006
2.  You may submit canceled checks, bills, statements, etc.
3.  2006 1040, schedule A

___E.  Any “other” situation you feel has warranted that you be considered for special conditions.
1.  2006 1040/1040A/1040EZ
2.  Non-reoccurring income, disability  (Documented proof to support situation)

All students requesting  this consideration after January 1, 2008, will be required to submit their Year 2007 Federal Tax Return before a special circumstances will be considered.

WARNING: If you purposely give false or misleading information on this form, a $10,000 fine, prison sentence, or both may result. This would be considered a federal offense. (Please print)

Complete this form with parent information if you are a DEPENDENT student or with your information if you are an INDEPENDENT student (and spouse if married).  You are considered DEPENDENT if parent (s) information was required on your financial aid application (FAFSA) when you originally applied for financial aid this award year.

Certification: All of the information on this form is true and complete to the best of my knowledge.  If asked by an authorized official, I agree to submit proof of the information that I have given on this form.  I realize that this proof may include a copy of my U.S., State, or Local tax return.  I understand that if I have grossly underestimated my expected income I MAY have to REPAY financial aid funds awarded back to the appropriate program. (Provide applicable signatures below.)
___________________________________  ___________________________________
Student’s Signature                               Date    Spouse’s Signature (if applicable)         Date
___________________________________  ___________________________________
Father’s  Signature (if applicable)          Date     Mother’s Signature (if applicable)        Date