SDSU: Special Circumstances Form

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Special Circumstances Form

This form may be used to document special circumstances to be considered for possible adjustments to the student's financial aid budget or the federal financial aid formula.

*Name Last, First, Middle
*SDSU ID # or Social Security #
*Address
*City
*State
*Zip
*Email
*Phone

Please check the appropriate special circumstance and write an explanation.

	Unusual medical and dental personal payments (not paid by insurance)
Amount

	Casualty or theft losses not reimbursed
Amount and type of loss

	Elementary and/or secondary private school tuition
Yearly Amount
Paid To

	Dependent care expenses
Monthly amount paid by family
Age(s) of child(ren)

	Travel expenses only for SDSU degree program
Miles driven per week
Estimated weekly travel expenses

	Other
Explanation

Written explanation for item(s) checked

*By typing the word yes in the box you are stating that all information is accurate to the best of your knowledge.

By submitting this form you are authorizing an SDSU official to verify that all information you have provided is correct and accurate.

South Dakota State University, Brookings, SD 57007 -- 1-800-952-3541
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