Fill - Free fillable 2019-2020 DEPENDENCY OVERRIDE FORM OFFICE OF FINANCIAL AID (CUNY Kingsborough Community College) PDF form

OFFICE OF FINANCIAL AID

2019-2020 DEPENDENCY OVERRIDE FORM

Students who do not meet the federal criteria to be considered independent based on the 2019-2020 Free Application

for Federal Student Aid (FAFSA) may submit this form with supporting documentation for review to determine if unusual

circumstances exist for granting a dependency status override. Dependency overrides are reviewed on a case-by-case

basis for students with extenuating circumstances and are evaluated each award year.

_____________________________________

__________________________________

________________________

Last Name

First Name

CUNYFirst ID #

The following are circumstances that will NOT be considered:

 Parent(s) refusal to contribute to the student’s education;

 Parent(s) did not claim student on their tax returns;

 Parent(s) unwillingness to provide information on the FAFSA;

 Student demonstrates total financial self–sufficiency.

PLEASE CHECK THE BOX THAT BEST DESCRIBES YOUR CIRCUMSTANCES:



A severe situation exists in your family, which prevents you from obtaining your parents’

information such as abandonment, physical/mental abuse, parental drug or alcohol abuse or

any other extenuating circumstances beyond your control.

Documents required for the review:

Personal Statement by Student

 Please submit a typed personal statement thoroughly detailing your circumstances. Your statement must

include:

 The last date you had any form of contact with your mother and father as well as the nature of that

contact,

 Your parents’ (mother and father’s) full name and location(s) and

 Explain how you have been supporting yourself.

Third Party statement from a Professional

 Please attach a letter from a third party (e.g. Social Worker, Teacher or Clergy Member) explaining your

circumstances and knowledge concerning your relationship with your parents. This letter should also include

the date you lost contact with your parents and their current knowledge of your dependency status. (Letter

must be typed on a letterhead and cannot be from a friend or relative.)

PLEASE ANSWER THE FOLLOWING QUESTIONS:

1. Where do you currently live (address)?: ________________________________________________________

2. What is your mother’s full name?______________________________________________________________

3. What is your mother’s current (or last known) address?_____________________________________________

4. When was the last time you had any contact or communication with your mother (month/year)? _____________

5. Describe the events that led to the separation between yourself and your mother:

_______________________________________________________________________________________

6. What is your father’s full name?_______________________________________________________________

7. What is your father’s current (or last known) address?______________________________________________

8. When was the last time you had contact or communication with your father (month/year)? __________________

9. Describe the events that led to the separation between yourself and your father:

_______________________________________________________________________________________

10. When did you stop living with your parents (month/year)?__________________________________________

11. Who did you live with once you stopped living with your parents?_____________________________________

12. Who are you currently living with? _____________________________________________________________

13. Did you work in 2017? Yes__ No__ If no, explain how you supported yourself in 2017:

_______________________________________________________________________________________

14. Are you currently working? Yes__ No__ If no, explain how you are currently supporting yourself:

_______________________________________________________________________________________

Note: You must first complete your 2019-2020 FAFSA before you can submit a Dependency Override. You may

also attach any additional documents which may demonstrate your need for this override.

Certification and Signature(s)

By signing this form, you certify that all of the information you provided is true and complete to the best of your knowledge and you

agree, if asked, to provide information that will verify the accuracy of your completed form.

Student’s Signature:

______________________________________

Date:

___________________

****************************************************************************************************************************************

For Administrative Use Only



Approved



Denied

FAA Signature:

________________________________________

Date:

_____________________

Reason for granting/denying request for Dependency Override:

Download
Save PDF to desktop

Email
Email completed PDF

Send for Signing
Email for others to sign

Print
Print document

NAME

2019-2020 DEPENDENCY OVERRIDE FORM OFFICE OF FINANCIAL AID (CUNY Kingsborough Community College)

View Audit Log
Print With Audit Log
Duplicate Document

Fill Online, Printable, Fillable, Blank 2019-2020 DEPENDENCY OVERRIDE FORM OFFICE OF FINANCIAL AID (CUNY Kingsborough Community College) Form

Related forms

Fillable 2019-2020 DEPENDENCY OVERRIDE FORM OFFICE OF FINANCIAL AID (CUNY Kingsborough Community College)

Fill Online, Printable, Fillable, Blank 2019-2020 DEPENDENCY OVERRIDE FORM OFFICE OF FINANCIAL AID (CUNY Kingsborough Community College) Form

Related forms

First 20 documents completely FREE!