NOTICE OF FINANCIAL AID STATUS



This document is to be used by students/parents requesting that the WDT Financial Aid Office use Professional Judgment (PJ) in the determination of a student’s eligibility for Federal Financial Assistance, and the resulting authorization thereof. This form can be completed to provide information based on my (and/or my spouses or parent’s) 2013 calendar year income, rather than my resources for the 2012 calendar year. A PJ request can be considered for exceptional, unique circumstances only. A student’s PJ request can be approved only once during their enrollment at WDT.

THIS DOCUMENT IS A FORM - PLEASE TYPE YOUR INFORMATION IN THE GRAY AREAS PROVIDED. USE THE “TAB” KEY ON YOUR KEYBOARD TO MOVE TO THE SPACES PROVIDED – DO NOT USE THE “ENTER” KEY.

PLEASE NOTE

1. You will be required to complete the 2013-14 Verification Form –SECTION 1 AND submit a SIGNED copy of your (and your spouses or parent’s) 2012 Federal TAX TRANSCRIPT (call the IRS at 1-800-829-1040).

2. You will be required to have this form notarized (The WDT Financial Aid Office has a notary on staff for your convenience).

3. All documentation requested (in addition to this form) must be submitted before any review will be taken.

4. Use of Professional Judgment is at the discretion of the WDT Financial Aid Administrator and all decisions are final.

5. A Professional Judgment will be considered only after ALL documentation is received, with final determination occurring 4 weeks after such receipt.

|SECTION B: Our household income will be less this year than in 2012 |

|for the following reasons: |

|PLEASE MARK (XX) ALL THAT APPLY |

| |

|      Unemployment or change in employment. |

|      Disability of student, spouse or parent. |

|      One-time income (ex. Inheritance, moving expense allowance, |

|IRA/pension. |

|      Death of spouse or parent. |

|      Divorce/Separation. |

|      Medical expenses not covered by insurance. |

|      Other (Please list:       |

|SECTION A: Student information |

Name:      

Address:      

City, ST, Zip:      

Phone:      

e-mail address:      

Last 4-digits of SS#:      

|Name |Relationship |Name & phone of employer or source|Estimated 2013 |Dates Employed |Reason for Change |

| | |of income |Income | | |

|      |      |      |      |      |      |

|      |      |      |      |      |      |

|      |      |      |      |      |      |

|      |      |      |      |      |      |

Please list any other information you would like to include for consideration of your Professional Judgment Request here, including your one-time income information that identifies the source of income and how the funds were utilized. INCLUDE COPIES OF DOCUMENTATION TO SUBSANTIATE YOUR REQUEST.

     

A Professional Judgment will be considered only after ALL documentation is received, with final determination occurring 4 weeks after receipt.

|The information I am providing is true and correct to the best of my knowledge. |

| | |

|  SUBSCRIBED AND SWORN BEFORE ME ON THIS ________ DAY OF |       |

|______________, ___________. |______________________________________________________________ |

| |Name of the Student OR Parent (if applicable) making this request |

|MY SEAL EXPIRES ON _________________________ |YOU MUST PROVIDE A PHOTO IDENTIFICATION AND SIGN IN FRONT OF A NOTARY. |

| | |

|NOTARY PUBLIC |Signature of the student OR Parent (if applicable) making this request Date |

-----------------------

800 Mickelson Dr.

Rapid City, SD 57703-4018

605-394-4034 or 800-544-8765

FAX: 605-394-2204

wdt.edu

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