Kaua`i Community College Financial Aid  2017‐18 Appeal for Special Circumstances      Professional Judgment Request Form    Award Year __________      Student Name                       

 

 

  Date ___________________ 

 

             _User Name/Student ID 

 

 

 

Parent(s) Name________________________________________________________________________    Please indicate the reason for requesting professional judgment consideration for yourself.  You must  document the reason for your request and submit this form along with any non‐returnable copies of  documents that support your request, to the Financial Aid Office.  Any requests submitted without  signature, date or documentation will not be considered.    Please complete, sign and submit this form with a letter of explanation and the required documentation  to the Financial Aid Office 

 

Reason for Request  







Marital Status Change ‐ to allow students/parent(s) to update their marital status if the school  determines the update is necessary to address an inequity or to reflect more accurately the  student’s ability to pay.  **Additional Documents Required: 1) Student and Spouses most recent  Tax Return Transcripts, 2) Dated Marriage Certificate 3) Letter stating new number of family  members who will be receiving at least 51% support from the student/spouse  Parental Non‐Disclosure‐ parent(s) refuse to provide required information to complete the  FAFSA, do not provide any financial support to the student, AND, will not provide support in the  future.  **Additional Documents Required:   1) Signed/dated statement from parent(s)  explaining in detail the circumstance for not providing information on the FAFSA, why support  has ended including the date, and confirming they will not provide support in the future.  OR, 2)  Signed/dated statements from student, and an independent third party such as counselor,  teacher, pastor, court system, etc, explaining the situation as it relates to the relationship with  the parent(s) and the extenuating circumstance.  PLUS Loan Exceptional Factors ‐ parent(s) are unable or unwilling to borrow a PLUS loan due to  exceptional factors.  **Additional Documents Required:  1) Official documentation showing  proof of one of the following extenuating circumstances pertaining to the parent:   Incarcerations, Bankruptcy indicating parent(s) are unable to incur additional debt, Parent  income is limited to public or federal assistance or disability benefits, Parent is not a US citizen or  permanent resident, but student is.  Loss of Income/Income Reduction  (Check all that apply) ‐ circumstances, such as a lost job or  pay cut, result in prior earnings that may not be an accurate representation of the annual  recurring income.  (Please complete section A below)   Student/Spouse   Parent(s) 

1 Kaua`i Community College 

3‐1901 Kaumualii Highway * Lihue, HI  96766 

  For use during Fall 2017, Spring 2018 & Summer 2018 

 

 

[email protected] 

Based on tax year 2015 

(808) 245‐8360 













**Additional Documents Required:  1) Letter from former employer, on letterhead  confirming termination, reduction in hours, pay cut, etc, 2) w‐2 Forms or pay statements  showing year‐to‐date income, 3) Unemployment compensation claim if applicable  One‐time Taxable Income (Non‐reoccurring income) ‐ a portion of income is a one‐time event;  therefore, earnings may not be an accurate representation of the annual recurring income.   **Additional Documents Required: 1) Dated documentation, from a third party, showing current  years income to date.  Excessive Medical/Dental Expenses ‐ medical or dental expenses that are medically necessary,   not covered by insurance, and paid, not owed by the student.  **Additional Documents  Required: 1)Receipts from payments made, or 2) Copies of cancelled checks or other payment  sources supporting that expenses were paid but not covered by insurance, 3) Copies of insurance  documentation supporting expenses that were covered as compared to other documentation  showing expenses not covered but paid, 4) Tax Transcripts  Exceptional Expenses ‐ unavoidable expenses, such an uninsured casualty losses, natural  disaster‐related expenses, funerals, or excessive legal fees.  **Additional Documents Required:  1) Copies of cancelled checks or other payment sources supporting that expenses were paid but  not covered by insurance, and 2) Copies of insurance documentation supporting expenses that  were covered as compared to other documentation showing expenses not covered but paid  Selective Service ‐ demonstrate, with evidence, that failure of male students 26 years old or  older to register was not knowing and willful.  **Additional Documents Required:  1) Status  information letter from Selective Service, 2) Letter from the student explaining situation and why  he/she was not aware of the requirement, 3) supporting documentation if any of the following  apply: Incarceration, Hospitalization, Military service, recent citizenship status change, address  changes  Parent(s) Enrolled in College ‐parent must be attending a Title‐IV‐eligible institution in a degree  seeking program with at least half‐time enrollment status and must be paying his or her own  tuition.  **Additional Documents Required:  1) Dated statement from the college verifying the  degree seeking program and number of credits the parent is enrolled in, 2) Copy of cancelled  check or other proof of payment to the institution for tuition.  Other Extenuating Circumstances:  ________________________________________________________________________    ________________________________________________________________________    ________________________________________________________________________    ________________________________________________________________________    ________________________________________________________________________    ________________________________________________________________________ 

2 Kaua`i Community College 

3‐1901 Kaumualii Highway * Lihue, HI  96766 

  For use during Fall 2017, Spring 2018 & Summer 2018 

 

 

[email protected] 

Based on tax year 2015 

(808) 245‐8360 

A. Income Table  INCOME FOR JANUARY 1, 2017       TO DECEMBER 31, 2017 

ACTUAL  01‐01‐2017 to  Today 

ESTIMATED  Today to 12‐31‐2017 

TOTAL  ACTUAL +  ESTIMATED 

Student 2017 gross income earned from  work (wages, salaries, tips, etc.)  Spouse 2017 gross income earned from  work (wages, salaries, tips, etc.)  Other taxable income: (enter in appropriate line)               Dividends ………………………..              Interest …………………………..              Pensions …………………………              Annuities ………………………...              Alimony …………………………              Capital Gains …………………….              Unemployment Compensation …..              Rental ……………………………              Partnerships………………………              S Corporations …………………...              Business/Farm Income ………..…              Combat Pay………………………              Other (specify what) ……………..  Child support received  Other untaxed income:(enter on appropriate line)             Workers Comp……………………             Payments to IRA/KEOGH………..             Tax Exempt Interest………………             Untaxed portions of pensions …….             Non‐educational veterans benefits..            Untaxed disability from all sources             Housing and other allowances for                     clergy or military……………..             Other (specify what) ……………...  Total income for 2017   













$  ………………………… ………………………… ………………………… ………………………… ………………………… ………………………… ………………………… ………………………… ………………………… ………………………… ………………………… ………………………… ……………………….  $  $  ………………………… ………………………… ………………………… ………………………… …………………….…  …………………………   ………………………… ………………………... $   

$  ………………………………… ………………………………… ………………………………… ………………………………… ………………………………… ………………………………… ………………………………… ………………………………… ………………………………… ………………………………… ………………………………… ………………………………… ………………………………..  $  $  ………………………………… ………………………………… ………………………………… ………………………………… ………………………………… ……………………………..…    ………………………………… …………………………………  $   

$  …………………………… …………………………… …………………………… …………………………… …………………………… …………………………… …………………………… …………………………… …………………………… …………………………… …………………………… …………………………… …………………………..  $  $  …………………………… …………………………… …………………………… …………………………… …………………………… ……………………………    …………………………… ……………………………  $   

I certify that the information is true and correct to the best of my knowledge. I understand that any false  statement or misrepresentation may be cause for denial, reduction, or repayment of financial aid.    _______________________________________     _______________________________  Student’s Signature            Date    _______________________________________     _______________________________ 

Parent(s) Signature   

 

 

 

 

Date 

Kaua`i Community College 

3‐1901 Kaumualii Highway * Lihue, HI  96766 

3   For use during Fall 2017, Spring 2018 & Summer 2018 

 

 

[email protected] 

Based on tax year 2015 

(808) 245‐8360 

PJ Request Form-1718.pdf

Page 1 of 3. 1. Kaua`i Community College 3‐1901 Kaumualii Highway * Lihue, HI 96766 kauccfao@hawaii.edu (808) 245‐8360. For use during Fall 2017, Spring 2018 & Summer 2018 Based on tax year 2015. Kaua`i Community College Financial Aid. 2017‐18 Appeal for Special Circumstances. Professional Judgment ...

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