7/25/2019 Parent Income Appeal Form 2015-2016

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Office of Student Financial Aid

5781 Wingate HallOrono, Maine 04469-5781

Tel: 207-581-1324Fax: 207-581-3261

REQUEST TO REVIEW FINANCIAL AID ELIGIBILITY !"#$%!"#&PARENT INCOME APPEAL FORM

StudentsName: Student ID #:

A) Appeal Categories B) Details C) Required Documentation: Submit each item listed.

Income changes from2014 to 2015, includingunemploymentbenefits:

___ Mother___ Father___ Step-parent

Receiving UnemploymentBenefits?

YES NO

Reason for Income Change:

___changed jobs___became unemployed___reduction in wages/hours

___reduction in taxable benefits___disability___other (attach explanation)

Date occurred: ________ MotherDate occurred: ________ FatherDate occurred: ________ Step-parent

1)

Attach a detailed letter of explanation.

2)

Attach 2015 Year-To-Date gross incomepaystubs obtained from all employers.

3)

Attach a current unemployment compensationpaystub.

4) Complete Expected 2015Parent Income chart onpage two.

Reduction ofUntaxed Benefit:

___Mother___Father___Step-parent

Type of benefit reduced or lost:

_________________________

Benefit amount: $ _________Date benefit lost: _________

1) Attach a detailed letter of explanation.

2)

Attach 2015 Year-To-Date gross incomepaystubs obtained from all employers.

3)

Attach documentation showing that benefits havebeen reduced or eliminated, including amounts.

4) Complete Expected 2015Parent Income chart onpage two.

Change of MaritalStatus:

Date of change:

____/___/______

MM DD YYYY

Type of Marital Change:

___separation/divorce___death of spouse

If your parents marital status changed afteryou filedyour FAFSA:

1) Attach a detailed letter explaining the maritalchange.

2) Attach official documentation: copy ofseparation/divorce/death certificate paperwork (if

available).3) Attach 2015 Year-To-Date gross income

paystubs obtained from allemployers.4) Complete Expected 2015Parent Income chart on

page two.

Other SpecialCircumstances:

(Not employment related)

Date occurred:_______________

1)

Attach a detailed letter of explanation.2) Provide documentation of the special circumstance.3) Attach 2015 Year-To-Date gross income

paystubs obtained from allemployers.4) Complete Expected 2015Parent Income chart on

page two.

MAINES LAND GRANT AND SEA GRANT UNIVERSITY

One of Maines public universities

*APPLICATIONS WILL NOT BE PROCESSED UNTIL ALL SUPPORTING DOCUMENTATION IS RECEIVED*

7/25/2019 Parent Income Appeal Form 2015-2016

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*SUPPORTING DOCUMENTATION REQUIRED*

Receipt of one-time income in 2014(for example: Itemized list of how funds were spent/invested:

inheritance, moving expense allowance, back-year Social

Security payments, IRA or pension distribution, etc.)

Total amount received: _______________

Source of income: ___________________

2. EXPECTED INCOME FOR 2015:

*Describe_________________________________________________________________________________

PLEASE NOTE: Your appeal will NOT be processed without all required supporting documentation.IF YOUR APPEAL REQUEST IS INCOMPLETE, IT WILL BE RETURNED TO YOU TO BE COMPLETED.

3. CERTIFICATION: All of the information on this form is true and complete to the best of my/our

knowledge. If asked by an authorized official, I/we agree to provide whatever documentation may benecessary to verify the information on this request.

___________Parent 1 signature Date Parent 2 signature Date(Required if income included) (Required if income included)

Date Given:_________________________ By:________________________________

The University of Maine does not discriminate on the grounds of race, color, religion, sex, sexual orientation, including transgender status and gender expression,national origin, citizenship status, age, disability, genetic information or veterans status in employment, education, and all other programs and activities. The following

person has been designated to handle inquiries regarding nondiscrimination policies: Director, Office of Equal Opportunity, 101 North Stevens Hall, 207.581.1226.

How funds were allocated(example: college tuition)

Amount ($)

EXPECTED 2015 PARENT INCOME

Income SourceACTUAL:

1/1/2015 to most recentpaystub

EXPECTED:Remainder of 2015

TOTAL 2015Actual + Expected

Fathers/stepfathers

wages (GROSS) $ $ $Mothers/stepmotherswages (GROSS)

$ $ $

Interest and dividendincome

$ $ $

Unemployment received $ $ $

Other taxable income(severance, alimony, rentalincome, etc.)*

$ $ $

Other nontaxable income(child support, workers

comp, employeecontribution to paymentplans, social security,etc.)*

$ $ $