2023-24 Notification of Special Circumstances

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Submit this document if there are special circumstances that should be taken into consideration during the initial evaluation for aid, or if after you receive your financial aid award you believe there were circumstances or financial details that were not addressed. This form is used as a supplement to the university need-based grant application and families should provide new financial details not originally included in the application documents. Any request for need-based re-evaluation must begin with the submission of this special circumstance form and the required documentation.

From the chart below select and check the box for the category most relevant to your situation. You can select multiple categories. Complete the sections for each category you have selected and submit this form and the required documentation to the Office of Financial Aid either by standard mail or by using the Office of Financial Aid secure upload process. Contact Martha Rowsey (540) 458-8717 to initiate a secure upload.

CategoryDocuments Required for AppealSections to be Completed

(Loss of job, reduction in wages, mandatory retirement, etc.)
  • Documentation of unemployment benefits
  • Copy of separation notice and final paystub
  • Documentation of severance package or any paid-out vacation and sick days
1, 2, 3, 6 & 7

(IRA withdrawal, one-time capital gain, inheritance, life insurance, etc.)
  • Documentation of one-time gain
11, 3, 4, 6 & 7

(Medical, excessive or untypical debt, home damage, two households, etc.)
  • Copies of bills designating the amount not covered by your medical insurance
  • Copies of invoices related to debt
  • Copies of bills related to damages not covered by your insurance
1, 3, 6 & 7

(support for family member(s) not living in household)
  • Documentation of support provided
  • Letter of explanation
1, 3, 5, 6 & 7
  • A personal statement and supporting documentation
1, 2, 3, 6 & 7

Section 1: Student/Parent Information

I/We certify the information submitted on this form is true and accurate. I/We will notify the Financial Aid Office immediately if our circumstances change.

Section 2: Household Income

Your university need-based grant eligibility for the 2023-23 academic year is based on your 2021 income. Complete this section if your resources for the 2023-2024 academic year will be significantly different. Enter your actual 2021 income in Column (A) and your updated income in Column (B). This section is complete only if you indicate in Column (B) the source (Option 1 or 2) of your updated income values.

  • Change in 2022 Income - There was a significant decrease in 2022 income from 2021. Enter actual 2022 income values in Column B. Submit complete 2022 federal tax returns with this form.
  • Change in 2023 Income - There is a significant decrease in current income from 2021. Estimate income for the calendar year 2023 and enter the estimated values in Column B. Your 2022 tax returns and other documentation to support income projections must be provided.
Income from Wages, Salaries, Compensation from Jobs
Income(A) Current 2021 Income(B) Income based on Tax Year 2022/2023
Father's gross wages/salary/tips (Attach W-2 form or pay stub)
Mother's gross wages/salary/tips (Attach W-2 form or pay stub)
Student's gross wages/salary/tips (Attach W-2 form or pay stub)
Net income from business or farm
Net rental/partnership/royalties/trust income
Capital gain/loss
Severance pay/vacation pay/sick pay
Unemployment Compensation
Workers' compensation/disability benefits
Alimony/spousal support
Social Security
Other taxable Income (describe below)
Untaxed Income
Income(A) Current 2021 Income(B) Income based on Tax Year 2022/2023
Child support received for all children
Veteran's Benefit
House Allowance (military, clergy, etc.)
Other untaxed income (i.e. foreign income exclusion, worker's compensation, untaxed pensions, SS benefits, etc.)
Income(A) Current 2021 Income(B) Income based on Tax Year 2022/2023
TOTALS (taxed and untaxed)

Section 3: Household Expenses

Next to each item, fill in the dollar amount of your family’s average monthly living expenses. If your family shares living expenses with others, indicate only that portion of expenses which your family pays. If an expense occurs other than monthly, please convert into a monthly average. Report only your family’s living expenses. DO NOT REPORT ANY BUSINESS OR RENTAL PROPERTY EXPENSES.

Monthly Family ExpensesAverage Amount per Month in 2022Average Amount per Month in 2023
Home Mortgage/Rent (Do not include insurance, property tax or mortgage on rental properties)
Property Tax
Home Maintenance (gardener, house cleaner, pool, etc.)
Food and Household Supplies
Utilities (gas, electric, water, etc.)
Phone, Cable, Internet
Child Care
Private, elementary/secondary school tuition
Insurance (home, car, health, life, etc.)
Medical expenses NOT covered by insurance
Transportation Expense (gas, maintenance, etc.)
Car 1 Payment (describe make/model below)
Car 2 Payment (describe make/model below)
Credit Card Payments
Personal Debt Payments (explain below)
Other (explain in Section 7)
Total Monthly Expenses

Section 4: Statement of One-Time Gain

Use the box below to identify the type of one-time gain you received in 2021 and did not receive in 2022.

Type of GainAmount
IRA Withdrawal
One-Time Capital Gain
Inheritance/Life Insurance
Other (explain below)

Section 5: Expenses Related to Family Member Support

If you are supporting other family members outside of your household, indicate below the monetary value of the expense and whether it occurred one time or occurs monthly.

Itemize all expenses in the space provided and attach supporting documentation (bills, receipts, etc.)

Section 6: Auxiliary Questions

For each vehicle, list the Make/Year/Purchase Price/Year Purchase or Leased/Is it Student Owned

Section 7: Additional Information and Explanation

Use the following space to present any explanations, details, or any other factors that are relevant to your submission of this form and which should be considered as a part of your review. If you need additional space, attach a separate page.