You must fill out this form if you are experiencing an exceptional family situation that is beyond your control.
The applicable section of the form must be completed and signed by an individual who is so authorized, based on the declared situation.
Digital transmission
Once you print and fill out the form, have the applicable section completed and signed by an individual who is so authorized, based on the declared situation, then sign it yourself and scan it. Use our Online Services to upload the completed form.
Other way to submit your document
If you are unable to submit this form digitally you can mail it to us. Print the form, fill it out, have the applicable section completed and signed by an individual who is so authorized, based on the declared situation, then sign it yourself and mail it to the address shown on the form itself.
