Fillable 2019-2020 DEPENDENCY OVERRIDE FORM (Sacramento City College)

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2019-2020 DEPENDENCY OVERRIDE FORM (Sacramento City College)

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RETURN TO FINANCIAL AID OFFICE:
2019-2020
DEPENDENCY OVERRIDE FORM
FSFA74
STUDENT INFORMATION
Last Name First Name M.I.
Student ID#
Under very limited circumstances, supported by documentation, the Financial Aid Office may override the federal government’s
requirement to submit parental information. Such circumstances include, but are not limited to, cases where your parent(s) are
incarcerated, mentally or physically incapacitated, abusive, or you do not know where they are and are unable to contact them.
Important note: The Financial Aid Office is prohibited by federal regulation from eliminating the requirement to provide parental
information based solely on your parents’ unwillingness to contribute to your educational expenses or provide the requested
information on the Free Application for Federal Student Aid (FAFSA). Additionally, your ability to demonstrate total self-sufficiency is
not an approved reason to waive the federal requirement to provide parental information.
Steps to Request a Dependency Override
1. Complete the *Parent 1 and Parent 2 information below and submit this form.
2. Attach a typed written statement that fully explains your current situation. Please include the following information in your
statement:
Why are you unable to provide the requested information for the above parent(s) on your FAFSA application?
When did you last live with your parent(s)?
When did you last have contact with your parent(s)?
When did you parent(s) last provide any form of support for you?
3. Attach written supporting documentation from a third party professional (minister, psychologist, social worker, counselor,
teacher, police officer, etc.). Please give the person the Guidelines for Third Party Letter.
If you are unable to provide supporting documentation from a third party professional, please complete this form and schedule
an appointment to discuss your situation with a financial aid staff member. If applicable, bring to the appointment copies of any
official documentation you may have that you feel supports your request (i.e. police reports, court records, agency records, etc.)
Parent Information
Please provide the name and address of both your parents below. If you do not know your parent(s) name or address write the word
unknown in the name and address fields. Do not leave any fields blank.
Parent 1
Parent 2
Name:
Address:
*Your legal parents are: biological, adoptive, or as determined by the state (for example, if the parent islisted on your birth
certificate). Grandparents, foster parents, legal guardians, widowed stepparents, aunt and uncles are not considered parents on this
form unless they have legally adopted you. If you have questions regarding who you should report as your parent(s), please contact
the Financial Aid Office.
DEADLINE to submit all required documentation:
Fall 2019: November 15, 2019 Spring 2020: April 17, 2020 Summer 2020: July 3, 2020
CERTIFICATION AND SIGNATURE
I certify that all the information reported is true and correct.
WARNING: If you purposely give false or
misleading information on this worksheet you
may be fined, sentenced to jail, or both.
Signature:_____________________________________________
Date: _______________________________
2019-2020
DEPENDENCY OVERRIDE FORM
FSFA74
Please detach this page to give to the third party who is writing your letter of support. Letters of support cannot come
from an employee of one of the Los Rios Colleges (American River, Cosumnes River, Sacramento City, Folsom Lake). Be
sure your name and student ID number are on the letter.
GUIDELINES FOR THIRD PARTY LETTER
Under very limited circumstances, supported by documentation, the Financial Aid Office may override the federal
government’s requirement for a student to submit parental information. Such circumstances include, but are not limited
to, cases where a student’s parent(s) are incarcerated, mentally or physically incapacitated, abusive, or the student does
not know where they are and is unable to contact them.
Our student application has identified you as a third party professional who has first-hand knowledge of the student’s
relationship with their parent(s).
Please write a letter, on letterhead (if available), that supports the student’s request to waive parental information on
the application for financial aid. The letter should answer the following questions:
1. What is your job title and company/organization name?
2. What is your relationship to the student?
3. How long have you known the student?
4. What is your knowledge of the student’s relationship with his/her parent(s) and/or what are the
circumstances that might make it difficult for the student to provide parental information on the application
for financial aid?
5. When did you become aware of this situation and/or how long have you known it to exist?
6. Please ensure you include a signature, date, address, and telephone number on your written statement.
Thank you for your time and effort in supporting our students in their educational journey.
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2019-2020 DEPENDENCY OVERRIDE FORM (Sacramento City College)

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Completed 5 September 2020

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