Fillable 2019-20 Dependency Override Form (Lehigh Carbon Community College)

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2019-20 Dependency Override Form (Lehigh Carbon Community College)

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OFFICE OF FINANCIAL AID
4525 Education Park Drive, Schnecksville, PA 18078
P 610.799.1133 | F 610.799.1798
E finaid@mymail.lccc.edu
2019-20 Dependency Override Form
Student Name Student ID
Instructions – Please use ink to complete this form.
First time applicants: Ensure that Sections 1, 2, 4 and 5 are complete and that
Uall of the required supporting
documentation is attached
U prior to submitting.
Renewal applicants: Ensure that Sections 1, 2, 3 and 5 are complete.
1. Verify your tax exemption status
a) Did anyone claim you as a dependent exemption on their 2017 Federal income tax return? (Check one)
No
Yes, Person’s Name:___________________________ Relationship to you:__________________
b) Did anyone claim you as a dependent exemption on their 2016 Federal income tax return? (Check one)
No
Yes, Person’s Name:___________________________ Relationship to you:__________________
2. Verify your current living arrangements
I do rent my own apartment or own my own home.
I do not live with my parents and I do not rent my own apartment or own my own home.
Please describe your current living arrangement:
U
3. URENEWAL STUDENTS ONLYU (must have previously approved Dependency Override on record)
Verify the status of your formerly documented situation
My situation has not changed. Skip to section 5
If your situation has changed, contact the Financial Aid Office to speak with a Financial Aid Representative who
can assist you with completing your financial aid application.
4.
UNEW APPLICANTS ONLY
Attach the following documentation for categories a, b, and c:
a) A personal letter of appeal explaining your request for a dependency override. Provide as much detail as possible
describing your extenuating circumstance and separation from your parents. The following information is
required:
• Include the estimated date of last contact you had with each parent and the frequency of contact with each
parent over the past five years.
• Explain why you cannot provide parental financial information on the 2019-2020 FAFSA.
• Describe your living arrangements over the past five years, including with whom you resided and who has
provided support to you.
• Make sure your name, Student ID, and signature are included in the letter.
- Page 1 of 2 -
OFFICE USE ONLY: DETDEP
OVER
_______________________________________________ __________________________________________
b) Supporting Documentation - Provide documentation that supports your dependency override appeal. Examples
of documents that should be submitted in support of your Dependency Override Appeal include, but are not
limited to:
• Copies of parent(s)’ death certificate(s).
• Letters of Guardianship.
• Proof of parent(s)’ incarceration.
• Proof of parent(s)’ commitment to a mental health or drug rehabilitation facility.
• Copy of a protection/restraining order that prohibits contact between you and your parent(s).
c) Letters from two individuals who can attest to your situation. The individuals cannot be related to each other
AND must reside at separate addresses. The letters should provide as much detail as possible describing your
extenuating circumstance and separation from your parents. All letters should be submitted on formal letterhead
and be signed and dated.
• One letter must be a formal 3
P
rd
party letter from a professional individual not related to you (counselor, P
social worker, clergy, police, etc.) and should include the professional’s name, title or position, work
address, signature and contact information.
• The second letter can be from somebody who can verify your situation and their contact information
should be provided.
5. Sign below
I certify that I do not receive any financial support, any other assistance, or any in-kind benefits from my parents for
food, housing, transportation, car payments, car insurance and/or medical insurance. I certify that the information
listed on the form and all supporting documents concerning my request for dependency override is correct and
complete.
I understand that upon review of the documents that I have submitted, the Lehigh Carbon Community College
Financial Aid Office may use professional judgment and require that I submit additional information. In addition, I
further understand that THE DECISION MADE BY THE FINANCIAL AID OFFICE REGARDING THE PROCESSING OF MY
APPEAL FOR DEPENDENCY OVERRIDE IS FINAL AND THERE IS NO ADDITIONAL APPEAL PROCESS.
Student Signature Date Daytime phone number
6. Return this form and any required supporting documentation (if applicable) in person, by mail, fax, or email to the
Office of Financial Aid.
- Page 2 of 2 -
OFFICE OF FINANCIAL AID
4525 Education Park Drive, Schnecksville, PA 18078
P 610.799.1133 | F 610.799.1798
E finaid@mymail.lccc.edu
2019-20 Dependency Override Policies
The Department of Education determines a student’s status as dependent or independent by the answers the student
provides in Step Three of the Free Application for Federal Student Aid (FAFSA). Federal student aid programs are based
on the principle that students (and their parent or spouse) are considered the primary source of support for
postsecondary education. Federal regulations permit Lehigh Carbon Community College to override a student's
dependency status for federal financial aid purposes, if unusual circumstances exist and can be documented. This
determination is made on a case by case basis.
To be considered for a Dependency Override, the student must complete the Dependency Override Form and provide
all documentation required to the Financial Aid Office. 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 student’s
request. The student will be notified in writing of the decision. THE FINANCIAL AID ADMINISTRATOR’S DECISION IS
FINAL AND CANNOT BE APPEALED TO THE U.S. DEPARTMENT OF EDUCATION.
USection I: Circumstances Given Consideration
Parental Support was terminated due to:
• A student’s voluntary or involuntary removal from his/her parent’s home due to an extreme situation that
threatened the student’s health and/or safety.
• Incapacity of parent(s) such as incarceration, mental or physical illness or the inability of the applicant to locate
the parent(s).
• Other extenuating circumstances that can be sufficiently documented.
USection II: Review Procedures
• All submitted documentation will be reviewed by a Financial Aid Administrator.
• An official notification of the Administrator’s decision will be sent to the student along with an explanation of
any further action necessary to complete his/her application for aid.
• If the student has filed a FAFSA for the year under review, the Financial Aid Administrator will make any
necessary corrections to the FAFSA.
• If the student has not yet filed a FAFSA for the year under review, they will need to complete the 2019-2020
FAFSA on the Web and indicate they are unable to provide parent information.
USection III: Renewal of a Dependency Override for Future Years
Students who were granted a dependency override in the previous academic year must renew their appeal each
subsequent year. They must complete the following:
• A statement verifying that the documented unusual family circumstance continues to exist for each subsequent
year the student applies to receive financial aid at Lehigh Carbon Community College.
• The 2019-2020 FAFSA indicating parent information is unable to be provided.
NONE of the conditions listed below, singly or in combination, constitute sufficient justification to approve a
dependency override:
• Parents refusing to contribute to the student's education.
• Parents unwilling to provide information on the application or for verification.
• Parents not claiming the student as a dependent for income tax purposes.
• Student demonstrating total self- sufficiency.
• Student is living at home (or with relatives) but paying rent.
• Student has ongoing arguments with parents and due to this, the parents have refused to help student.
• Student has chosen to leave parents and put him/herself through college.
• Student lives with or has a step-parent who refuses to provide support.
OFFICE USE ONLY: DETDEP
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2019-20 Dependency Override Form (Lehigh Carbon Community College)

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Completed 4 October 2020

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