2025-2026 Special and Unusual Financial Circumstances

All required fields are marked with “required.”

Student Information

Name of Student

Date of Birth Use MM-DD-YYYY format.

Student ID

Phone Number

Instructions

If you have one of the special circumstances listed below that might affect the amount you or your family are expected to contribute toward your education, call 919-209-2036 to make an appointment after you complete this form and attach the proper documentation.

The Financial Aid Office will review your documentation to determine whether an adjustment may be made. The family contribution may or may not be adjusted, and you will be notified after the information is reviewed.

If your income has not significantly changed from 2023, do not complete this form.

Special Circumstances and Required Documentation

Tuition expenses at an elementary or secondary school. If you or your parents paid private elementary or secondary school tuition for family members other than yourself for a reason other than choice, attach a signed statement explaining why it was necessary to pay private school tuition. Also attach documentation of the amount of tuition, not fees, room, or board, paid in 2023.
Unusual medical or dental expenses not covered by insurance. If you or your parents paid unusually high medical or dental expenses in 2023, attach a copy of the 2023 tax return Schedule A, Itemized Deductions. If you did not file a Schedule A, attach statements from doctors, dentists, hospitals, or other providers showing the amount paid in 2023. Do not include amounts reimbursed by insurance.
Loss of employment. If your parents earned money in 2023 and lost employment for at least ten weeks in 2024, attach a signed statement with the date employment ended and complete item 8. If you are an independent student and you or your spouse worked full time in 2023 and lost a job in 2024, attach a signed statement with the date employment ended and complete item 8.
Loss of nontaxable income or benefits. If you, your parents, or your spouse received unemployment compensation or untaxed income or benefits in 2023 and completely lost that income or benefit for at least ten weeks in 2024, attach a signed statement identifying the income or benefit lost, the date it ended, and complete item 8.
Separation or divorce. Attach a copy of the separation or divorce agreement. If you do not have one, attach a signed statement. Complete item 8.
Death. If your parent or spouse received income in 2023 and has died, attach a copy of the death certificate. If the death certificate is not available, attach a statement. Complete item 8.
Other circumstances. If your family has unusual financial circumstances not identified on this form, attach an explanation and complete item 8. Example: one-time income from a 401(k) distribution.
Estimated income for 2024 calendar year. Complete the income section below and provide documentation for any amount listed. Examples include current unemployment benefits, a final check stub from a lost job, a current check stub, 2023 and 2024 federal tax forms, and W-2 forms if available.

Estimated Income for January 1, 2024 through December 31, 2024

Write zero (0) if an item does not apply.

Taxable Income
Income Type	Parent 1	Parent 2	Student	Spouse
Wages, salaries, tips	Wages, salaries, tips — Parent 1	Wages, salaries, tips — Parent 2	Wages, salaries, tips — Student	Wages, salaries, tips — Spouse
Pensions	Pensions — Parent 1	Pensions — Parent 2	Pensions — Student	Pensions — Spouse
State unemployment benefits	State unemployment benefits — Parent 1	State unemployment benefits — Parent 2	State unemployment benefits — Student	State unemployment benefits — Spouse
Alimony	Alimony — Parent 1	Alimony — Parent 2	Alimony — Student	Alimony — Spouse
Other taxable income: specify source(s)	Other taxable income — Parent 1	Other taxable income — Parent 2	Other taxable income — Student	Other taxable income — Spouse

Untaxed Income and Assets
Income or Asset Type	Parent 1	Parent 2	Student	Spouse
Social Security benefits	Social Security benefits — Parent 1	Social Security benefits — Parent 2	Social Security benefits — Student	Social Security benefits — Spouse
Aid to Families with Dependent Children (AFDC)	AFDC — Parent 1	AFDC — Parent 2	AFDC — Student	AFDC — Spouse
Child support received	Child support received — Parent 1	Child support received — Parent 2	Child support received — Student	Child support received — Spouse
Other untaxed income benefits	Other untaxed income benefits — Parent 1	Other untaxed income benefits — Parent 2	Other untaxed income benefits — Student	Other untaxed income benefits — Spouse
Total anticipated income	Total anticipated income — Parent 1	Total anticipated income — Parent 2	Total anticipated income — Student	Total anticipated income — Spouse
Cash and savings	Cash and savings — Parent 1	Cash and savings — Parent 2	Cash and savings — Student	Cash and savings — Spouse

Assets

Do not include the value or debt of the home.

Parent Assets
Asset Type	Value	Debt
Other real estate and investments	Parent other real estate and investments value	Parent other real estate and investments debt
Business and farm	Parent business and farm value	Parent business and farm debt

Student and Spouse Assets
Asset Type	Value	Debt
Other real estate and investments	Student or spouse other real estate and investments value	Student or spouse other real estate and investments debt
Business and farm	Student or spouse business and farm value	Student or spouse business and farm debt

Certifications and Signatures

You must print, sign, and date this document and return it to the Financial Aid Office with supporting documentation.

By signing this form, if adjustments are needed, I authorize Johnston Community College Financial Aid Office to make changes electronically on my behalf.

Each person signing below certifies that all of the information reported is complete and correct.

Warning: If you purposely give false or misleading information, you may be fined, sent to prison, or both.

Student Signature

Student ID Number

Date

Student's Spouse Signature

Date

Parent Signature Required for dependent students.

Date