Special Circumstances Appeal Form for Returning Students

Appeal Information

*Denotes a required field.

Loyola Student ID*

Student First Name*

Student Last Name*

Student Phone Number*

Student Loyola Email Address*

Parent 1 Name*

Parent 2 Name

Have you submitted your 2023-24 FAFSA?*

Yes

No

Are you unable to complete your 2023-24 FAFSA?*

Yes

No

Why are you unable to complete your 2023-24 FAFSA?*

You will need to submit your 2023-24 FAFSA before you can submit this form. Please refer to your Self-Service Portal to confirm receipt of your 2023-24 FAFSA.

Have you submitted your 2023-24 CSS Profile?*

Yes

No

You will need to submit your 2023-24 CSS Profile before you can submit this form. Please refer to your Self-Service Portal to confirm receipt of your 2023-24 CSS Profile.

Have you received a financial aid award for the 2023-24 academic year?*

Yes

No

Individual Experiencing Income Change* (Select all that apply)

Parent 1

Parent 2

Student

Which year has this income change affected?*

2022

2023

Parent 1 Income

Provide actual and anticipated income for 2023 for Parent 1 only. Report annual figures, not monthly or hourly.

Type of Income Change for Parent 1*

Effective Date*

Total Earned Income 01/01/2023 through Present*

Anticipated Earned Income Now through 12/31/2023*

Total Unemployment Benefits 01/01/2023 through Present*

Anticipated Unemployment Benefits Now through 12/31/2023*

Severance Pay*

Interest/Dividend Income*

Business/Real Estate Income*

Taxable IRA/Pension/Annuity Distributions*

Other Taxable Income (state tax refunds, alimony, taxable SS, etc.)*

Untaxed Social Security Benefits*

Child Support Received for all Children*

Child Support Paid for all Children*

Your Contribution to Tax-Deferred Retirement Plan (401k, 403b, etc.)*

Other Untaxed Income*

Parent 2 Income

Provide actual and anticipated income for 2023 for Parent 2 only. Report annual figures, not monthly or hourly.

Check this box if the student resides in a one-parent household as indicated on the 2023-24 FAFSA or the 2023-24 CSS Profile.

Student resides in a one-parent household.

Type of Income Change for Parent 2*

Effective Date*

Total Earned Income 01/01/2023 through Present*

Anticipated Earned Income Now through 12/31/2023*

Total Unemployment Benefits 01/01/2023 through Present*

Anticipated Unemployment Benefits Now through 12/31/2023*

Severance Pay*

Interest/Dividend Income*

Business/Real Estate Income*

Taxable IRA/Pension/Annuity Distributions*

Other Taxable Income (state tax refunds, alimony, taxable SS, etc.)*

Untaxed Social Security Benefits*

Child Support Received for all Children*

Child Support Paid for all Children*

Your Contribution to Tax-Deferred Retirement Plan (401k, 403b, etc.)*

Other Untaxed Income*

Student Income

Provide actual and anticipated income for 2023 for Student only. Report annual figures, not monthly or hourly.

Type of Income Change for Student*

Effective Date*

Total Earned Income 01/01/2023 through Present*

Anticipated Earned Income Now through 12/31/2023*

Total Unemployment Benefits 01/01/2023 through Present*

Anticipated Unemployment Benefits Now through 12/31/2023*

Severance Pay*

Interest/Dividend Income*

Business/Real Estate Income*

Taxable IRA/Pension/Annuity Distributions*

Other Taxable Income (state tax refunds, alimony, taxable SS, etc.)*

Untaxed Social Security Benefits*

Child Support Received for all Children*

Child Support Paid for all Children*

Your Contribution to Tax-Deferred Retirement Plan (401k, 403b, etc.)*

Other Untaxed Income*

Additional Information

Summarize your extenuating circumstances:*

Required Documentation and Instructions

Additional documentation may be required to consider your appeal. Your financial aid counselor will contact you with instructions on how to upload the requested documents via your Self Service Portal (loyola.edu/selfservice).

Examples of possible required documentation as applicable to your appeal:

Signed 2021 federal 1040 tax return and all schedules, 2021 W2 form(s) if not already submitted. Verify receipt through your Self-Service Portal (loyola.edu/selfservice)
Signed 2022 federal 1040 tax return and all schedules, 2022 W2 form(s) if not already submitted. Verify receipt through your Self-Service Portal (loyola.edu/selfservice)
Signed 2023-2024 Dependent Verification Worksheet if not already submitted. Verify receipt through your Self-Service Portal (loyola.edu/selfservice)
Letter from employer(s) verifying reduction in hours or date of separation. Include anticipated return date
Documentation of severance pay from employer
Documentation of unemployment benefits
Letter from physician documenting disability and effect on work status
Statement from issuing agency certifying termination of benefit, including effective date of termination
Copy of last pay stub prior to change and copy the most recent pay stub
Copy of death certificate
Date of Divorce or Separation; Proof of separate residences

Student and Parent Certification

I certify that the information submitted for this appeal is true and complete to the best of my knowledge. I agree to provide all support documentation required. I understand that failure to comply may result in the cancellation of this appeal. I further understand that if I have provided information in previous appeals, this may be reviewed for accuracy and it may impact the outcome of this and/or any future appeal. I understand any assistance provided in response to this appeal is for the 2023-2024 academic year. I understand future consideration requires annual completion of the Loyola financial aid application process, need-based aid eligibility, and the availability of funds.

Electronic Student Signature*

Date*

Electronic Parent Signature*

Date*