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  After you print and sign the form, submit it to the Financial Aid Office using one of the following options:

21-22 Request for Income Recalculation – Financial Aid
 Student Name     Last:      First:      M.I.: 
 ctcLink ID Number:    --   Birthdate:  //   MM/DD/YYYY
   Social Security Number: --
  Use this form if you, your spouse, or your parents’ 2021 income is, or will be, less than the 2019 income reported on your 2021–22 FAFSA (Free Application for Federal Student Aid). We use the information on this form to determine if we can recalculate your eligibility for financial aid. This request will not be processed until your financial aid file is complete. 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
  You must submit all required documentation listed on the checklist below. 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, Separation/Divorce, 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 last year to date pay stub for all 2021 employers and documentation of any untaxed income you list in sections B or C of this form, for you and/or your spouse or parent(s).
Section B: Supplemental Benefits
 Check any of the following benefits you or your family have or will receive in 2021:
 Untaxed Social Security Income (SSI or SSDI)  SNAP Benefits (Food Assistance)  Free or Reduced Price Lunch
 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 2021?          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 be counted as income. Provide documentation from the Employment Security Office that you received unemployment benefits during 2021.
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 Parents of Dependent Student or Spouse
   Jan. – June 2021  July – Dec. 2021  Jan. – June 2021  July – Dec. 2021
 Income Earned from Work: Student/Parent 1 $ $ $ $
 Income Earned from Work: Spouse/Parent 2 $ $ $ $
 Other Taxable Income        
 Interest and Dividends $ $ $ $
 Business Income $ $ $ $
 Pension/IRA Distribution $ $ $ $
 Other: $ $ $ $
 Untaxed Income        
 Child Support Received $ $ $ $
 Disability Payments: L & I, VA, etc. $ $ $ $
 Spousal Maintenance/Alimony $ $ $ $
 Other: $ $ $ $
Benefits Student Amount per Week Student Amount Earned to Date 2021 Spouse/Parent per Week Spouse/Parent Amount Earned to Date 2021
 Unemployment $ $ $ $
2021 Income From Work - Student
Employer Information
If more than 3 employers or sources of income, please list additional on a separate sheet of paper.		 Complete this section if still working for this employer
Employer Start Date End Date
leave blank
if current
employer		 Total Gross Earned to Date (before taxes) Pay Periods
1=weekly
2=bi-weekly
3=semi-monthly
4=monthly		 Hours Per Week Hourly Pay Gross Amount Earned per pay period
$ $ $
$ $ $
$ $ $
2021 Income From Work - Spouse/Parent
Employer Information
If more than 3 employers or sources of income, please list additional on a separate sheet of paper.		 Complete this section if still working for this employer
Employer Start Date End Date
leave blank
if current
employer		 Total Gross Earned to Date (before taxes) Pay Periods
1=weekly
2=bi-weekly
3=semi-monthly
4=monthly		 Hours Per Week Hourly Pay Gross Amount Earned per pay period
$ $ $
$ $ $
$ $ $
Section D: Household Information
Write the names of ALL household members that you or your parents/spouse will support between July 1, 2021 and June 30, 2022 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, 2021 and June 30, 2022. 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 College
Yes  No
Yes  No
Yes  No
Yes  No
Yes  No
Yes  No
I certify that the information provided on this form is accurate to the best of my knowledge. I understand that this information is used to determine eligibility for financial aid and that I may be subject to legal penalties if I knowingly or purposefully give false or misleading information.
 
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