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Financial Aid

Special Circumstance Request Form

Your Name:
Date of Birth:
Your Email Address:
Address:
City:
State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip:
What academic year is this request for?:	2010-2011 2011-2012
Please indicate what special circumstances you are requesting for review and write your detailed explanation of special circumstances.
Special Circumstances:	Independent Status Unusual Medical/Dental Expenses Paid Out of Pocket Loss of Income/Employment Received One Time Income Did Not Maintain Satisfactory Academic Progress Loss of Social Security Benefits Previously Defaulted on Student Loan(s) Unusual Debts/Expenses
Other Circumstance:	Briefly explain
Please write an explanation of your situation:
Please enter the following code:

Please be prepared to submit supporting documentation if asked. Our office will notify you in approximately 7-10 days following the submission of this form of any additional documentation needed or the results of our review.

Please be informed
Our decision is final and cannot be appealed to the U.S. Department of Education.