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2009-2010 Request for Change to Independent Status
Student’s Name Social Security Number/Student ID
Federal laws expect your parent(s) to share the responsibility of paying for your educational expenses. If the directions on your financial aid application instruct you to provide parent information, then by law, for financial aid purposes, you are dependent on your parent(s). If there are extraordinary circumstances and you cannot obtain parental information, the Financial Aid office may consider a petition for an override of Federal Regulations. Please complete the questions below and submit it to your Financial Aid office. Address: ______________________ ______________________ Home Phone: _________________ Date of Birth: ___________ Last date you: Lived with your parent(s): Spoke with your parent(s): ________________ ________________
Select one of the following reasons for your request: Abandonment by both parents (no contact whatsoever with either parent for at least one year) and no financial support received from them for at least one year Abusive family environment Incarceration or institutionalization of both parents Parents whereabouts are unknown Parents lacking the physical or mental capacity to raise you Other: (describe reason on a separate sheet) Documentation to include with your request: On a separate sheet, write a detailed statement describing the circumstances of your independence from your parents. Include with your statement an explanation of the following items, not limited to: - What is your present living arrangement/whom do you live with? - Explain why you are unable to obtain parental information At least two letters from references who can confirm the circumstances of your request. (Note: At least one of the letters should be from a professional source, i.e. Counselor, Clergy, Employer, etc…). The second letter may be from a relative but not an immediate family member. Attach additional documents that will support your request to be considered as an independent student. Examples of documentation could include physician statements, incarceration paperwork, legal paperwork, etc... Note: Please include your name and student ID on every page of any additional documentation submitted with this request.
I hereby certify that all the information on this form and any attachments hereto are true, complete, and accurate to the best of my knowledge. I understand that any false statements or misrepresentations will be cause for denial, reduction, withdrawal, and/or repayment of financial aid, and may subject the filers to a fine or imprisonment or both, under the provisions of the United States Criminal Code.
Signature:
Date:
Return signed form and supporting documentation to your local campus or via fax at (866) 484-3789 Questions? Call us at (866) 257-3763