2021-22 COVID-19 Special Circumstances Form

2021-22 COVID-19 Special Circumstances Form

Required Documentation & Instructuions

Please also submit the following documents to financialaid@tsu.edu. Include your student ID and student name on all documents and COVID-19 Appeal Documents in your email subject line.

Letter from your employer(s) verifying reduction in hours or date of separation. Include anticipated return date if applicable
Copy of last pay stub prior to change and copy of most recent pay stub
Severance statement if applicable
Unemployment benefit statement or a signed statement that you will not receive unemployment benefits

If you did not utilize the IRS Data Retrieval Tool to import income information onto your FAFSA, you may be required to submit a 2019 IRS Tax Return Transcript and copies of 2019 W-2 forms. We will contact you via email if this is necessary.

T-Number*

Student First Name*

Student Last Name*

Student Phone Number*

Phone

Student Email*

Parent 1 Name*

Parent 2 Name

Have you submitted the 2021-22 FAFSA*

Yes

Who in your family is experiencing income challenges?*

Select all that apply

Select

Please summarize how COVID-19 has impacted your family’s financial circumstances:

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 2021-2022 academic year. I understand future consideration requires annual completion of the Texas Southern financial aid application process, need-based aid eligibility, and the availability of funds.*

E-signature of Student

Please enter full name

E-signature of Parent

Please enter full name

Send me a copy of my responses

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