Scottsdale Community College
2016-2017 Special Circumstances Worksheet
A. Student Information
__________________________________________
Last Name
First Name
MI
XXX-XX Social Security Number
@maricopa.edu
Maricopa Email Address (Note: all electronic
communication will be sent to your Maricopa Email Address)
Phone Number with Area Code
Student ID Number
B. Special Circumstances Worksheet
Special Circumstances are unplanned situations that may impact a family’s ability to contribute towards a student’s
education. For financial aid purposes, the term “family” is defined as one of the following:



You, or
You and your spouse if you are married, or
You and your parent(s) if their income was included on your financial aid application.
YOU WILL BE REQUIRED TO SUBMIT ALL REQUESTED DOCUMENTATION TO SUPPORT YOUR
CIRCUMSTANCES FOR YOUR “FAMILY”. THE DEADLINE TO SUBMIT AN APPEAL IS April 14, 2017.
Please be advised, additional documentation may be requested or you may be asked to meet with a Financial Aid
Counselor. Please be advised there is no guarantee that your financial aid eligibility will be changed or that additional
funds will be awarded.

All appeals require signed 2016 federal tax return(s) (if you are required to file taxes) for the student,
including you and your parent(s) if their income was included on your financial aid application, or you
and your spouse if you are married.
o If you are required to file taxes, then w2’s, 1099, taxes, etc. can be submitted beginning 1/16/2017.
o If you are not required to file taxes, w2’s, paystubs, 1099, etc. can be submitted after 9/1892016.
C. Appeal Categories
Death of a spouse or parent after you have applied for federal financial aid (which included spouse or
parent information). Copy of death certificate required.
No longer employed full time for in 2016, OR there has been a reduction in salary in 2016 due to downsizing, a
demotion, change in employer(s), etc… that has resulted in lower pay.
Since filing the Free Application for Federal Student Aid (FAFSA), the student and spouse or the student’s
parents have separated pending a divorce, or have gotten divorced. (provide documentation for the parent
that the student lived with most in the last 12 months. If the student did not live with one parent more than
the other, then provide documentation for the parent that provided the most financial support during the last
12 months or during the most recent calendar year.)
Decrease in child support received OR increase in child support paid to ex-spouse in 2016.
SCC 9000 E. Chaparral Rd, Scottsdale AZ 85256 FAX:480-423-6591
D. Statement
Please provide a statement regarding your circumstances, the statement should include: a brief explanation of your
special circumstances with all relevant dates of employment, and an explanation on how your family will provide basic
living expenses (shelter, food, clothing, medical/dental, transportation) in 2016 (attach additional statement if needed).
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
E. Appeal Checklist – Did you include all these documents?



Signed 2016 federal tax return(s)
Student Income, including Parent Income if your parent’s information was included on your financial aid
application
Other documentation or letters as requested
YOUR REQUEST FOR A SPECIAL CIRCUMSTANCE WILL NOT BE REVIEWED UNTIL ALL DOCUMENTATION IS
COMPLETED. THE DEADLINE TO SUBMIT AN APPEAL IS APRIL 14, 2017.
For Financial Aid Office Use Only.
Approved
Denied
Other
FAO
SCC 9000 E. Chaparral Rd, Scottsdale AZ 85256 FAX:480-423-6591
Date
F. Student/Spouse Estimated Year Income
You have indicated a change in your 2016 income. List amounts beginning January 1, 2016 through December 31, 2016.
Include the below information for you and your spouse if you are married. Complete all questions, if “0” enter “0”, do
not leave blank.
Student
Spouse
Income earned from work. Included a copy of your last pay
stub from each employer worked for or currently working for.
$_____________
$_____________
Estimated income, if currently seeking employment.
$_____________
$_____________
Unemployment compensation. Include letter from
unemployment office regarding benefits paid and/or being
received.
$_____________
$_____________
Interest/Dividend Income.
$_____________
$_____________
Payments to tax deferred pension and savings plans. Include
untaxed portions of 401K and 403B plans.
$_____________
$_____________
Withdrawal from Retirement/Pension Accounts.
$_____________
$_____________
Disability Income.
$_____________
$_____________
Social Security.
$_____________
$_____________
Child Support Received.
$_____________
$_____________
Child Support Paid.
$_____________
$_____________
Welfare benefits, including Temporary Assistance for Needy
Families.
$_____________
$_____________
Cash, Savings and Checking Balances.
$_____________
$_____________
Other untaxed income.
$_____________
$_____________
The information above is a true estimation of my “family’s” 2016 income.
_________________________________________________________________________________________________
Student Signature
Date
___________________________________________________
Telephone Number
SCC 9000 E. Chaparral Rd, Scottsdale AZ 85256 FAX:480-423-6591
G. Parent Estimated Year Income
If your parents income information was included on your financial aid application you are required to submit the below
information.
You have indicated a change in your 2016 income. List amounts beginning January 1, 2016 through December 31, 2016.
Include the below information for you and your spouse if you are married. Complete all questions, if “0” enter “0”, do
not leave blank.
Parent
Parent
(mother)
(father)
Income earned from work. Included a copy of your last pay
stub from each employer worked for or currently working for.
$______________
$______________
Estimated income, if currently seeking employment.
$______________
$______________
Unemployment compensation. Include letter from
unemployment office regarding benefits paid and/or being
received.
$______________
$______________
Interest/Dividend Income.
$______________
$______________
Payments to tax deferred pension and savings plans. Include
untaxed portions of 401K and 403B plans.
$______________
$______________
Withdrawal from Retirement/Pension Accounts.
$______________
$______________
Disability Income.
$______________
$______________
Social Security.
$______________
$______________
Child Support Received.
$______________
$______________
Child Support Paid.
$______________
$______________
Welfare benefits, including Temporary Assistance for Needy
Families.
$______________
$______________
Cash, Savings and Checking Balances.
$______________
$______________
Other untaxed income.
$______________
$______________
The information above is a true estimation of my “family’s” 2016 income.
_________________________________________________________________________________________________
Parent Signature
Date
_________________________________________________________________________________________________
Parent Name
Telephone Number
SCC 9000 E. Chaparral Rd, Scottsdale AZ 85256 FAX:480-423-6591