Fillable 2017 18 Request Independent Status Form (Eastern Wyoming College)

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2017 18 Request Independent Status Form (Eastern Wyoming College)

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Financial Aid Office
3200 West C Street
Torrington, WY 82240
p: 307.532.8224
f: 307.532.8222
financialaid@ewc.wy.edu
2017-2018
Request for
Independent Status
(Dependency Override Appeal)
Section 480(d) of the Higher Education Act of 1965, as amended (HEA), defines an independent student as someone who fits into one
of the following categories. A student is considered independent if he or she:
• Was born before January 1, 1994;
• Is an orphan, in foster care or is a ward of the court at any time since age 13;
• Is an emancipated minor as determined by a court in his/her state of legal residence;
• Is in legal guardianship as determined by a court in his/her state of legal residence;
• Is an unaccompanied youth who is homeless or at risk of being homeless as determined on or after July 1, 2016, by a school
district homeless liaison or the director of an emergency shelter or transitional housing program;
• Is a graduate or professional student;
• Is married;
• Has legal dependents other than a spouse for whom he/she provides more than half their financial support; OR
• Is a student for whom a financial aid administrator makes a documented determination of independence by reason of other
unusual circumstances. This documented determination is the Dependency Override.
Examples of unusual circumstances include:
•
family abuse or neglect,
•
parental abandonment, or
•
other situations where contact between you and your parents is non-existent.
According to guidance from the U.S. Department of Education, the following circumstances do not qualify as unusual circumstances
and do not merit a dependency override:
•
Parents refuse to contribute to the student’s education;
•
Parents are unwilling to provide information on the Free Application for Federal Student Aid (FAFSA) or to complete the
verification process;
•
Parents do not claim the student as a dependent for income tax purposes;
•
Student demonstrates total self-sufficiency;
•
Incarceration or confinement.
Definitions:
Ward of the Court – Page AVG-25 of the 2016-2017 Federal Student Aid Handbook: “A student is a ward of the court if the court
has assumed legal custody of him/her. In some states the court may impose its authority over a juvenile who remains in the legal
custody of his/her parents; such a student is not a ward of the court. Also, incarceration of a student does not qualify him/her as a ward
of the court.” Having a legal guardian does not automatically make a student a ward of the court but will make the student independent
on a separate FAFSA question. A legal guardian must have been appointed by the court. In most cases, the parent’s rights will also
have been terminated for the child to have a guardian and/or be a ward of the court.
Homeless – At any time on or after July 1, 2016, lacking fixed, regular and adequate housing, which includes living in shelters, motels
or cars, or temporarily living with other people because you had nowhere else to go.
Unaccompanied - At any time on or after July 1, 2016, not living in the physical custody of a parent or guardian.
Youth - Twenty-one years of age or younger, or still enrolled in high school as of FAFSA application date.
Please Note:
•
You will be notified in writing of the appeal committee’s decision. This process may take up to 30 days.
•
If your appeal is incomplete or submitted without the necessary documentation, processing of your appeal will be delayed
until the additional information is obtained. Appeals must be submitted by mid-term of the semester for which you are
requesting aid.
•
Submission of an appeal does not guarantee your request will be approved.
•
If approved, the Dependency Override is valid for only one academic year. Approval in one year does not guarantee
approval in following years. Your status must be reassessed each academic year.
•
An approval by the EWC Financial Aid Appeal Committee is relevant only to your application at EWC. Each institution to
which you apply must make its own determination of your dependency status. No school is obligated to accept a decision
made by another school.
In addition to completing this form and providing all situation-specific supporting documentation, ALL APPEALS MUST INCLUDE
the following documentation:
A typed (or neatly hand-written), signed statement that explains in detail the extreme, unique, and/or unusual family
circumstances that prevent you from obtaining and providing your parents’ information for your financial aid application .
Signed copy of your 2015 Federal Income Tax Return (or Tax Transcript) and W-2 forms. If you were not employed, include
an explanation of how your living expenses were covered in your statement.
Documentation of your current year income to date from all income sources.
A copy of your current lease agreement, mortgage statement or rent receipt. If you do not have a lease or mortgage in your
name, include an explanation of your current living situation in your statement.
Court or other official documentation of your status (e.g. guardianship, HHS documentation).
A signed statement from your guardian (if applicable) detailing your circumstances.
MUST INCLUDE: A signed statement from a third party who is knowledgeable of your family situation and can verify the
reason you are unable to provide your parents’ information. This third party should be someone unrelated to you. The
statement should be on letterhead and should list the person’s relationship to you and a contact number. Appropriate
third-party statements are from clergy, school counselors, teachers or similar professionals.
___________________________________________________________ ____________________ __________________________
Last Name First Name M.I. EWC Student ID Number Social Security Number (last four digits)
___________________________________________________________ _______________________________________________
Mailing Address (include apartment number) E-mail Address
___________________________________________________________ _______________________________________________
City, ST, Zip Phone Number (include area code)
A. Severe circumstances within your family prevent you from obtaining your parents’ financial information.
B. You were married and maintained a residence apart from your parents and your spouse’s parents. You are now divorced,
have no dependents, maintain a residence separate from your parents, and pay all the expenses from your own income.
Additional required documentation:
o Proof of divorce.
o Copies of utility or other bills in your own name.
C. Loss of a dependent.
Additional required documentation:
o Documentation of loss of dependent.
How long have you lived at your current address? __________ Years Months
Is the lease or mortgage in your name?
Yes (attach a copy of your lease or mortgage)
No (attach a copy of your current lease agreement, mortgage statement or rent receipt. If you do not have a lease or
mortgage in your name, attach a statement explaining your current living situation)
Mother’s name Father’s name
Address Address
City, State, Zip City, State, Zip
A: STUDENT INFORMATION
REQUIRED DOCUMENTATION
B: REASON FOR SUBMITTING APPEAL
C: EXPLANATION OF SPECIAL CIRCUMSTANCES
Over
D: CERTIFICATION AND SIGNATURE
Do you live with your parent(s) during school breaks? Yes No
When did you last live with your parent(s)?
When did your parent(s) last provide any monetary support for you?
When did you last have contact with your parent(s)?
How often do you have contact with your parent(s)?
Are you covered by your parent(s) medical insurance? Yes No
Are you covered by your parent(s) car insurance?
Yes No
Do you have your own medical and/or car insurance?
Yes No
If yes, attach a copy of your current policies
Do you own your own vehicle?
Yes No
If yes, attach a copy of your title, registration, and loan
Are all utilities (electricity, gas, phone) in your name? Yes No
Cash support from people other than your parents (includes amounts paid by others for bills in your name).
Amount of cash support: $
In-kind support is support other than money (e.g., friends giving you food or allowing you to live with them rent free).
Value of in-kind support: $
CURRENT EXPENSES – Estimate your current monthly expenses and how they are met.
EXPENSE
MONTHLY COST
Housing
$
Utilities
$
Food
$
Clothing
$
Transportation
$
Medical insurance
$
Cell Phone
$
Other
$
CURRENT INCOME
TYPE OF INCOME
MONTHLY AMOUNT
Wages
$
Untaxed income
$
Cash support (listed above)
$
Other
$
By signing this worksheet, I certify that all of the information reported is complete and correct. I agree to provide additional information
or documentation deemed necessary by the Financial Aid Appeal Committee, including court documentation. I also acknowledge that I
have read and agree to comply with all verification policies as stated by EWC in the College Catalog and on the EWC website. Failure
to submit information in a timely fashion may result in the application being filed as inactive with no further consideration and no
federal aid for the academic year.
Student signature: _________________________________________________ Date: ___________________________
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, sentenced to jail, or both.
11/2016
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2017 18 Request Independent Status Form (Eastern Wyoming College)

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Completed 23 July 2020

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