Office of Financial Aid | 1950 Third Street | La Verne, CA 91750 | Phone: (800) 649-0160 | Fax: (909) 448-1629
202ϰͲϮϬϮϱ Professional Judgement Request
The University of La Verne’s Office of Financial Aid recognizes the formula used to calculate your ^ƚƵĚĞŶƚŝĚ/ŶĚĞdž (^/) may
not accurately reflect special circumstance for individual students and/or families. Financial Aid Counselors have the authority
to take into consideration unique circumstances not reflected on the Free Application for Federal Student Aid (FAFSA). If you
feel you have extenuating circumstances (see list in Step 2) that affect the data reported on your FAFSA, please submit a
Professional Judgment Request along with supporting documentation of your circumstance as listed. Changes resulting from
this review do not guarantee an increase in your financial aid eligibility. Failure to submit requested documents in a timely
manner will delay the processing of a decision. Include your Student ID on all documents. Please check your student email for
correspondence from our office.
Submit this form and all supporting documents by uploading it via the Portal: https://myportal.laverne.edu/ Alternatively,
you may:
1. Fax documents to (909) 448-1629; be sure to include your student ID number on each page.
2. Submit documents in person to the Office of Financial Aid in Woody Hall, corner of 3rd & B in La Verne.
3. Mail documents:
University of La Verne
Office of Financial Aid
1950 Third Street
La Verne, CA 91750
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Student Information
Student ID: Date of Birth:
First Name: Middle Name: Last Name:
Address:
City: State: ZIP Code:
Phone: Email:
Step 1: For the person(s) affected by the special circumstances, please provide a detailed personal letter of explanation of the
circumstance. The statement must include:
• Dates: Provide the dates of events leading to the circumstance, including whether the circumstance is ongoing
• Amounts: Report the amounts for any income or benefit received or lost, of expenses paid or support provided
Office of Financial Aid | 1950 Third Street | La Verne, CA 91750 | Phone: (800) 649-0160 | Fax: (909) 448-1629
• Names/Relationships: Names of the person(s) impacted by the circumstance and their relationship to one
another/the student
Step 2: Please check the applicable boxes for the special circumstances(s) you wish to be considered.
*Additional documents may be requested. *
Special Circumstance
Explanation
Person(s)
Affected
Required Documents
܆
Income Loss
Student/spouse and/or your parent(s) had a
significant loss of income in 202
2, 2023
and/or 202
4 due to a period of
unemployment, a change of job or going from
full
-time to part-time employment. Loss of
employment or
substantial reduction in
income from work must have lasted at least 6
weeks.
Student
Spouse
Parent
• 202Ϯ and 202ϯ IRS Tax Return
Transcripts
• W-2s and/or 1099 statements
• Unemployment payment record
• Letter from employer(s) on
letterhead, certifying the last date
of employment or reduction of
work hours or pay rate
܆
Benefit Loss
Student/spouse and/or parent(s) received
unemployment compensation and/or
untaxed benefit in 202Ϯ or 202ϯ, but have
completely lost the Benefit in 2022, 2023
and/or 2024. The untaxed income or benefit
must be from a public or private agency, from
a company or from an authorized Individual
due to a court order.
Student
Spouse
Parent
• Statement from agency with
effective dates of benefits
܆
Divorce/ Separation
Student or parent separated or divorced after
filing a FAFSA
Student
Spouse
Parent
• 202Ϯ and 202ϯ IRS Tax Return
Transcripts, W-2s and/or 1099
• Copy of divorce decree.
• If not legally separated, proof of
different addresses (utility bill,
lease indicating period of
separation).
܆
Death
Death of spouse or parent after filling a FAFSA
Student
Spouse
Parent
• Copy of death certificate
•
Social Security Benefits (if
applicable)
•
Most recent paystubs
܆
Exceptional
Medical/Dental
Expenses
An unusually high amount of
medical/dental expenses paid out of pocket
during 202Ϯ (does not include payments
made by insurance)
Student
Spouse
Parent
• 202Ϯ and 202ϯ IRS Tax Return
Transcripts,
• W-2s and/or 1099 statements
• Medical/dental expenses should
have receipts
܆
Other
Other substantial factors impacting
household or income not listed above
(thorough explanation required).
Student
Spouse
Parent
• Documentation verifying the
circumstances described,
including but not limited to copies
of checks, invoices, billing
statements, etc. May be subject to
further required documents.
Office of Financial Aid | 1950 Third Street | La Verne, CA 91750 | Phone: (800) 649-0160 | Fax: (909) 448-1629
202ϰ-202ϱ Professional Judgement Request
Step 3: CERTIFICATION
I declare with my signature below, that the information I am providing is true and correct. At the end of the calendar year, I
authorize the Office of Financial Aid at the University of La Verne to verify my income with the appropriate agencies. I
understand that if the University of La Verne determines that the information was not accurate, I may be required to REPAY any
additional financial aid I have received as a result of this request. I understand that the Professional Judgment form submitted
without required supporting documentation and letter of explanation will not be reviewed. I also understand that submission of
a Professional Judgment form does not guarantee that my financial aid will be adjusted and that I am responsible for any
outstanding balance owed to the university.
Student's Signature: Date:
Parent's Signature (If Applicable): Date:
