Fill - Free fillable 1920 Dependency Override Application (Northwest State Community College) PDF form

(OVER)

Student Name: ____________________________________ NSCC ID number: N________________________

Street Address _________________________________ City________________ State_________ Zip____________

Phone: _________________ Email Address: ______________________________ Date of Birth: _____/_____/_____

This appeal is used to request a dependency override for federal financial aid. It is used after you have filed your FAFSA and indicated that

you have special circumstances which prevent you from providing parental information.

The Federal Student Aid Program determines a student’s status as dependent or independent by the answers the student provides on the eight

questions listed in Step 3 of the Free Application for Federal Student Aid (FAFSA). Students are classified as dependent or independent

because federal student aid programs are based on the principle that students (and their parents or spouse) are considered the primary source

of support for postsecondary education. The Dependency Override process is used to address on a case by case basis a student who claims to

be independent but does not meet the federal criteria. The student must demonstrate a unique and extenuating circumstance.

The following provides information and explains the procedure used to determine a student’s eligibility for a “Dependency Override.” A

Financial Aid Administrator will review the student’s appeal by examining the supporting documentation provided by the student and will

either approve or deny the students request and notify the student in writing. The decision is final and cannot be appealed to the U.S.

Department of Education.

THE FOLLOWING IS NOT CONSIDERED A UNIQUE AND EXTENUATING CIRCUMSTANCE

 Self-sufficiency of the student

 Parent’s unwillingness to complete the parent section of

the FAFSA

 Parents refuse to contribute to the student’s education

 Not residing at the parent’s residence

 Not being claimed as a dependent on your parent’s tax

return

 Student’s desire for grants instead of loans

CIRCUMSTANCES GIVEN CONSIDERATION WHERE PARENTAL SUPPORT HAS BEEN TERMINATED

 Documented abandonment

 Parental drug abuse

 Parental mental incapacity

 Physical or emotional abuse

 Severe estrangement from parents

 Parental Incarceration

Dependency Override Appeal Process

_____Step #1: Complete your 2019-2020 Free Application for Federal Student Aid and have it sent to NSCC (School Code 008677).

_____Step #2: Complete this form using an ink pen.

_____Step #3: Attach a typed letter. Make sure your name, Student ID, date, and signature are included on the letter.

 In your own words tell us why you are requesting a dependency override.

 Describe your relationship with your parents and include any circumstances surrounding the situation

 Include information about how you provide for yourself.

 If you are or have received support from friends and relatives, you must describe the nature of the support.

 Attach supporting documentation if available.

_____Step #4: Have at least two individuals complete the “Dependency Override Documentation” section of this appeal.

 These individuals should be adults who have direct knowledge of the situation, who are not relatives.

 One individual must be a professional whom you have sought treatment or assistance. Professionals include guidance counselors,

doctors, lawyers, family counselors, social workers, law enforcement officers, clergy members, etc.

 If a family member, who is not your parent, has raised you or is currently supporting you, submit an additional statement from that

family member.

 The Dependency Override Documentation must be the original form completed and signed by each individual.

We understand the sensitive nature of these circumstances; therefore all documentation received by our office will be kept

confidential.

2019-2020 Dependency

Override Application

Prior Petition for Dependency Override Approval

____ Check here if you have been approved for a Dependency Override Appeal in 2018-2019 aid year by our office and your situation

has not changed. You do not have to resubmit the documentation you previously provided. Just complete this page of the form and

submit to the Financial Aid Office.

Parent Information: Father Mother

Name: __________________________________________ Name: __________________________________________

Address: __________________________________________ Address: __________________________________________

__________________________________________ __________________________________________

Phone: __________________________________________ Phone: __________________________________________

Student Information:

1. Did anyone claim you on their federal tax return for 2017? ____Yes ____No 2018? ____ Yes ____No

If yes for 2017, provide Name: _________________________________ Relationship to you: _______________________________

If yes for 2018, provide Name: _________________________________ Relationship to you: _______________________________

2. What are your current living arrangements (who do you live with)? ____________________________________________________

3. Current Expenses:

Type of Expenses

Monthly Amount

How Paid

Housing

Utilities

Food

Clothing

Transportation

Medical/Insurance

Personal/Miscellaneous

4. When was the last time you lived with your parent(s)? Month/Year:___________________________

5. When did your parent(s) last provide any form of support? Month/Year:___________________________

Student Certification:

I certify that all of the information provided on this form and all attached documentation is true and correct. I also understand that it will be used to override

federal regulations regarding my dependency status. I fully understand that to falsify any information in order to receive Federal Title IV funds is a federal

offense and can be punishable by fines and/or other penalties. I understand that if my situation changes in any way, if I reside with my parents or receive any

financial support from them, that I must report this information to the Financial Aid Office.

____________________________________________ __________________________

Student’s Signature Date

Northwest State Community College does not discriminate on the basis of race, color, national origin, sex, gender identity, disability, religion or age in its programs or

activities.

For Financial Aid Office Use Only:

Outcome: ____ Eligible for Dependency Override Corrections Entered in Banner (RNAOVxx): Date ____________

____ Not eligible for Dependency Override

Comments: ____________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________

Financial Aid Authorization: ____________________________________________________________ Date:____________________________________

Student Name:

NSCC ID number:

Northwest State Community College • 22600 State Route 34 • Archbold • OH • 43502

Phone: 419-267-1333 • Fax 419-267-5587 • finaid@northweststate.edu

Dependency Override Documentation

Professional

Student Name: ___________________________________ NSCC ID number: N________________________

TO BE COMPLETED BY A PROFESSIONAL WHO HAS WORKED WITH THE STUDENT’S FAMILY.

(EXAMPLES OF PROFESSIONAL PEOPLE INCLUDE HIGH SCHOOL COUNSELOR, TEACHER, SOCIAL

WORKER, CLERGY, PHYSICIAN, LAWYER, or FAMILY THERAPIST).

The above named student has applied for financial aid at Northwest State Community College and has indicated that he/she is

unable to provide us with parent information due to extenuating family circumstances.

Please provide a brief statement regarding your knowledge of the student’s family history and relationship with parent(s).

_______________________________________________________________________________________________________

Why do you believe that the student is unable to provide parent(s) information for financial aid purposes?

_______________________________________________________________________________________________________

Last date the student: 1. Received financial support from parent(s)? ____________ 2. Lived with parent(s)?___________

How long have you known the student? _______________________________________________________________________

What is your professional relationship with the student? __________________________________________________________

Name of Business or Employer: _____________________________________________________________________________

Business Address: _____________________________________ Business Phone #:_____________________________

Your name (please print): ________________________________ Your Title: __________________________________

Your Signature: ________________________________________ Date: _______________________________________

Northwest State Community College • 22600 State Route 34 • Archbold • OH • 43502

Phone: 419-267-1333 • Fax 419-267-5587 • finaid@northweststate.edu

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Dependency Override Documentation

Non-Relative Individual

Student Name: ___________________________________ NSCC ID number: N________________________

TO BE COMPLETED BY AN INDIVIDUAL WHO IS AN ADULT AND HAS DIRECT KNOWLEDGE OF THE

STUDENT’S SITUATION, WHO IS NOT A RELATIVE. THIS PERSON MUST NOT LIVE AT THE SAME

ADDRESS AS THE STUDENT.