Financial Aid Appeal Form - Kamehameha Schools Page 4
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Identify source and amount of income.
8. Loss of one-time income
•
•
Documentation of IRA rollover, if applicable.
Capital gains, IRA withdrawals,
•
Written statement with detail explanation and itemize list of “how the
Miscellaneous income,
money was spent.”
Gambling earnings
a.
Provide documentation: HUD Statements, Educational Loan
Statements, Legal Fees and/or Major Medical/Hospital Invoices.
•
9. Medical/dental (non-cosmetic only)
Total expenses incurred.
expenses not covered by insurance.
•
Copy of the most current medical/dental bill statement showing amounts
paid and outstanding.
•
Documentation from agency verifying date and amount of benefits
10. Loss of social security/child support
terminated and amount received (if any) in the current year for all family
members.
•
11. Loss of disability benefits
Copy of disability benefits termination letter disclosing effective date.
•
Proof of disability status. (i.e. medical documentation, letter from
vocational rehabilitation, etc.)
12. Death of family member
Copy of the death certificate and documentation regarding any anticipated
insurance and/or untaxed income for the current year.
13. Other
Case by case requirements may be requested. Supporting documentation is
required.
Document No. 065AI
Rev. 12/17/2015
Page 4 of 4
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