Summary: Office of Student Financial Services
Polytechnic Institute of New York University
Request Form for Special Circumstances/Professional Judgment Review
Award Year 2010-2011
Student Name: ____________________________________________ NYU-POLY ID: ________________
NYU-POLY recognizes that situations occur which may affect a student's eligibility for federal financial aid.
Complete this form and submit it to the Office of Student Financial Services with the appropriate documentation.
Please allow up to three weeks for the review process. All decisions are final. Incomplete requests will be
returned and will not be reviewed until we have all the required documentation.
Step 1: Check the appropriate circumstance that applies to you:
_____Parent, Independent Student or Spouse is currently unemployed and has been unemployed for at least 4
weeks. (Enclosed documentation that provides date of termination/release and amounts of any unemployment
benefits to be received, amount of income earned before job termination and signed student statement.)
_____Independent Student who previously worked at least 35 hours/week and has left their employment in order
to attend college full-time. (Letter from former employer and signed student statement.)
_____Parent, Independent Student or Spouse currently unemployed and has been unemployed for at least 8
weeks due to disability. (Disability documentation and statement form student and/or parent)
_____Untaxed income of benefits received 2009 has ceased completely. (Enclose documentation from the agency
providing the benefits.)
_____Death of parent or spouse, which occurred after applying for financial aid. (Enclosed a copy of death