Supplemental Information Form

Section A: Student Information

Student's Name:
Permanent Address:

A student’s eligibility for need-based financial aid is determined by the student’s/spouse and/or parent’s income and assets from the prior calendar year (2019 for the 2021-2022 award year) based on information provided on the 2021-2022 FAFSA (Free Application for Federal Student Aid).  However, adjustments can be made if the family’s financial situation changes or if the family incurs unusual expenses for any of the following reasons:

Section B: Request for Special Consideration Based on Special Circumstances

1. Reduction in income - Estimate 2021 income below if there has been (or will be) a reduction from income in 2019.  Please determine unemployment benefits before projecting income due to job loss.

$
$
$
$
$
$
$
Interest, dividends, alimony received, capital gains (or losses), ext.
$
Sum of lines A - G
$
Include the same types of income identified on question #94 of the FAFSA
$
Sum of lines H-I
Explain the factors that contribute to the high cost of living in your area.
Please itemize and explain exceptional medical and/or dental expenses paid in 2019. Do not include expenses paid by health savings or flex spending accounts.
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5. Are there children (K-12) in the household that have tuition cost for their schooling?
If yes you will be asked to fill out the elementary and secondary tuition section
Please itemize, providing specific dollar amounts and explanation of any other unusual circumstances.

Elementary / Secondary Tuition

Indicate the total tuition paid in 2019 - 2020 for children in grades K-12: 

Name of Child
$
Name of Child
$
Name of Child
$
Name of Child
$
$

Reductions to Tuition Charges - List any tuition assistance received from:

$
$
Student scholarships / financial aid
$
Tuition Reduction Incentive Program
$
grandparents/other family members, friends, fund-raisers, etc.
$
$
Subtract total reductions (B) from total tuition (A)

Section C: Certifications

I/We certify that all of the information on this form is true and complete 

to the best of my/our knowledge.

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Date*
Parent Name
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Date
Spouse Name
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Date