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___________________
