2022-2023 Request for Re-evaluation Dependent Students Student Name:
Hofstra ID #:
If you believe you have extenuating financial circumstances, or there is a current and significant reduction in family income, you may submit this form and supporting documentation to request a re-evaluation of your federal financial aid. Please be advised that this request can only be accepted from students that are admitted to Hofstra and have a valid 2022-2023 Free Application for Federal Student Aid (FAFSA) on file. Submission of this request does not guarantee an adjustment to your financial aid award. If your situation meets one of the circumstances detailed below, please submit: ☐ A copy of the student’s and parent’s signed 2020 Federal Tax Return or Transcripts (which can be obtained from the IRS at www.irs.gov/transcript). If you used the IRS Data Retrieval Tool in the FAFSA, you do not need to submit this. ☐ A copy of the student’s and parent’s signed 2021 Federal Tax Return or Transcripts, if you are requesting that we update the FAFSA information to reflect this tax year (when available). ☐ Copies of the student’s and parent’s W-2(s) for 2020 and 2021.
Reason for Re-evaluation Request Please check the box and submit all required documentation that applies to your circumstance. Special Circumstance ☐ Loss of Wages or Employment ☐ Termination, Layoff, or Company Closing ☐ Retirement ☐ Disability ☐ Job Change or Permanent Reduction in Work Hours ☐ Loss of Benefits (taxable social security, untaxed court-ordered child support, or other untaxed benefits) ☐ Divorce / Separation
☐ Death of a Parent ☐ Excessive Medical Expenses
☐ Catastrophic Occurrence
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Additional Documentation Needed Name of Parent: Effective Date: ☐ Letter from employer stating effective date of separation, termination, or job change ☐ Last paystub, if change occurred in 2022 or 2023 ☐ Most recent paystub from all income earners in household ☐ Unemployment benefit documentation (must be dated within 90 days of submission) ☐ Severance payment documentation ☐ Statement from company/agency explaining loss of benefits Name of Parent: Effective Date: ☐ Copy of divorce decree, separation document, or letter from attorney ☐ Or copies of noncustodial parent’s most recent paystub and utility bill to verify separate residence ☐ Copy of death certificate Expenses must exceed 7.5% of your adjusted gross income (AGI) as per the IRS threshold guidelines ☐ Copy of Federal 1040 Schedule A for the applicable tax year ☐ Copies of insurance statements / receipts to show out of pocket costs One-time event (such as natural disaster) resulting in substantial loss ☐ Copy of Federal 1040 Schedule A for the applicable tax year ☐ Copies of insurance statements, bills, receipts, or estimates to show how expenses exceeded insurance coverage