Student Name ____________________________________________ ID ______________________
Las Positas College
REQUEST FOR CONSIDERATION OF A CHANGE IN DEPENDENCY STATUS
2019-2020
Eligibility for financial aid is based on the assumption that students and their parents are
primarily responsible for paying for education. If the directions on your financial aid application
instruct you to provide parents information, then by law you are a dependent of your parents. In
unusual hardship cases, the Financial Aid Office may be able to assist a student who is
technically dependent if the student can make a compelling case showing that it is unhealthy or
impossible to provide the parental information. This will apply to situations such as the
following examples: 1) student suffered verifiable/documented parental abuse and contact with
the parent would put the student in danger emotionally or physically, or 2) parent is mentally
handicapped. In such cases, the student must complete this form and provide written
documentation, preferably from a third party professional (e.g. minister, psychologist, social
worker, high school/college counselor, etc.) to support his/her claim. You are encouraged to
provide strong verifiable documentation to support your case.
The following are NOT circumstances which may be considered to change a student’s dependency
status:
The student
has been supporting himself/herself for a time
The student has been supported by other relatives or friends for a time
The student does not live with his/her parents
The student is angry with the parents (or the parents are angry with the student) and wishes
not to speak to them
The pa
rents are able but unwilling to provide their information
The parents are living in another country.
DIRECTIONS: After reading the information above carefully, if you feel you can substantiate an
extenuating circumstance, complete a FAFSA at www.fafsa.ed
.gov excluding parental information. Then
complete this form and submit it to the financial aid office. If approved, adjustments will be made to
your FAFSA which will allow you to be considered independent. DOCUMENTATION must be
provided!
Student's Name: ____________________________________________SSN:__________________
(Last) (First) (M)
Address: ___________________________________________________Phone No._______________
City/State/Zip:________________________________________ Email:____________________
Is your mother living? Yes No Is your father living? Yes No
Are your biological parents still married to each other? Yes No
If not, what year did they separate/divorce? __________________________________________
Where does your mother live?_____________________________________________________
Where does your father live?______________________________________________________
Which parent did you live with last? Mother Father
When did you move out of your parent’s home? Month/Year___________________
When was the last time you had any contact with your parents? Month/Year___________________
When did your parents last provide any form of support? Month/Year___________________
Student Name ____________________________________________ ID _______________________
Explain who you live with, since when, and how much rent you pay each month.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
How do y
ou support yourself and meet your living expenses?
____________________________________________________________________________________
____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Please explain the circumstances involving your parents' inability or unwillingness to support you. Attach
a separate sheet of paper if necessary to provide additional information that you feel supports your request
to be considered as an independent student.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
You must provide documentation of the above information by submitting a statement from a third party
professional who is aware of your situation and can corroborate the facts you present. Examples of
such persons would include clergy, social workers or other social service personnel, court officials,
teachers, counselors and police officers. They must attach a statement that would support your claim,
and provide contact information.
FOR OFFICE USE ONLY
Dependency Override granted 2019-2020: _____ Dependency Override denied 2019-2020:_____
Remarks:__
_______________
_______________
_______________
_______________
Signature of Financial Aid Staff Reviewer:____ Date:_____
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