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After you print and sign the form, bring the form to the Enrollment Services Office on the first floor of Lynnwood Hall, OR fax the form to 425-640-1159, OR mail the form to: 
Financial Aid Services Office 
Edmonds Community College 
20000 68th Ave W 
Lynnwood, WA 98036 

17-18 Request for Income Recalculation – Financial Aid
 Student Name     Last:      First:      M.I.: 
 Student ID Number:    --   Birthdate:  //   MM/DD/YYYY
   Social Security Number: --
  Use this form if you, your spouse, or your parents’ 2017 income is, or will be, less than the 2015 income reported on your 2017-18 FAFSA (Free Application for Federal Student Aid). The change of circumstance must have occurred at least 3 months prior to submitting the request and is not expected to be temporary. We use the information on this form to determine if we can recalculate your eligibility for financial aid. Before we process a recalculation, you must have a completed financial aid file. Recalculation requests will be processed at the time of determining your initial eligibility. However, if you submit this form AFTER your file has already been processed, please allow up to 8 weeks to process this request.
Section A: Change of Circumstances
  Follow the checklist below and provide the requested documentation and information. Incomplete requests cannot be processed and will delay any adjustment to your eligibility.
  Submit a detailed statement explaining your circumstances (For example: loss or reduction of employment, loss of child support or other benefit, or Separation/Divorce or death of spouse/parent, high medical costs not covered by insurance or other benefit). Be sure to include the date of the event or circumstance.
  Submit documentation to verify your situation (letter of termination of employment, Unemployment Benefit Statement, divorce decree, death certificate, etc.).
  Submit an IRS tax return transcript of your 2016 taxes. (If you are a dependent student, be sure to include your parent/s 2016 tax information as well). Copies of 1040 tax returns are not accepted.
  Submit all 2016 W2’s, including parent(s) if you are a dependent student.
  Submit all 2017 year to date paystubs and verification of any untaxed income listed in section B or C for you/spouse, and parent(s) if you are a dependent student.
NOTE: We cannot accept copies of the 1040 tax returns. An IRS Tax Return Transcript can be requested by:
  • Online Request: Go to , under the Tools heading on the IRS homepage, click "Get a Tax Transcript ". Make sure to request the "IRS Tax Return Transcript" and NOT the "IRS Tax Account Transcript."
  • Telephone Request: 1–800–908–9946
  • Paper Request Form: IRS Form 4506T–EZ or IRS Form 4506–T
Section B: Supplemental Benefits
 Check any of the following benefits you or your family have or will receive in 2017:
 Untaxed Social Security Income (SSI or SSDI)  SNAP Benefits (Food Assistance)  Free or Reduced Price Lunch
 AFDC/TANF  WIC (Public Health Nutrition Program)  Section 8 Housing (Subsidized Housing)
Have you, your spouse, or one of your parents (if you are a dependent student) received Unemployment Benefits during 2017?          Yes           No     
If yes, when did or will your benefits start?
Date Picker
and when did or will your benefits end?
Date Picker
 For recalculation, unemployment benefits may not be counted as income. Provide documentation from the Employment Security Office that you received unemployment benefits during 2017.
Section C: Income
 Complete the chart below for each of the time periods indicated. Use projected figures for those time periods in the future. Make your projected figures as realistic as possible. IMPORTANT: Do not leave an area blank.
Source of Income Student and Spouse Parents of Dependent Students
   Jan. – June 2017  July – Dec. 2017  Jan. – June 2017  July – Dec. 2017
 Income Earned from Work: Student/Father $ $ $ $
 Income Earned from Work: Spouse/Mother $ $ $ $
 Other Taxable Income        
 Interest and Dividends $ $ $ $
 Business Income $ $ $ $
 Pension/IRA Distribution $ $ $ $
 Other: $ $ $ $
 Untaxed Income        
 Child Support $ $ $ $
 Disability Payments: L & I, VA, etc. $ $ $ $
 Spousal Maintenance $ $ $ $
 Other: $ $ $ $
Section D: Household Information
Write the names of all household members that you or your parents/spouse will support between July 1, 2017 and June 30, 2018 below. Also provide the name of the college for any household member attending college at least half-time and enrolled in a degree or certificate program at any time between July 1, 2017 and June 30, 2018. Attach a separate page if needed for additional household members.
Full Name Age Relationship Will this household member be enrolled in college for at least 6 credits? If yes, what college will they be attending
Self Yes  No Edmonds Community College
Yes  No
Yes  No
Yes  No
Yes  No
Yes  No
Yes  No
I/We certify that the information provided on this form is accurate to the best of my/our knowledge. I/We understand that this information is used to determine eligibility for financial aid and that I/we may be subject to legal penalties if I/we knowingly or purposefully give false or misleading information.
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