Fillable 2019-2020 Dependency Appeal 11400 Robinwood Drive Hagerstown, MD (Hagerstown Community College)

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2019-2020 Dependency Appeal 11400 Robinwood Drive Hagerstown, MD (Hagerstown Community College)

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19CDEPAQ 1/11/2019
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.
Name: __________________________________________________ HCC ID: _____________
Last Name First Name MI
FAFSA regulations never require parents to help pay for education, but they often insist on considering their
financial resources when evaluating your financial need. If you were most recently supported by legal
guardians, relatives, or friends, you cannot list their income and personal information on your FAFSA
.
CHECK ONE RESPONSE TO EACH QUESTION BELOW:
Yes No
Were you born before Jan. 1, 1996?
Are you currently serving on active duty in the U.S. armed forces for purposes other than
training?
Are you married? (Answer “Yes” if you are separated but not divorced.)
Are you a veteran of the U.S. armed forces?
Do you have children who receive over half of their support from you?
Do you have other dependents who receive over half of their support from you?
Are your parents deceased?
At any time after turning 13 years old, were you a ward or dependent of the court?
At any time after turning 13 years old, were you in foster care?
Are you an emancipated minor? (Requires legal court documents)
Are you in legal guardianship with someone other than your parents?
If you answered yes to any of the above questions you may be required to submit legal documents
to verify your answer. You do not need to complete this form. You are independent for financial aid
purposes and will not need to include parent’s information when completing the FAFSA.
If you answered no to all of the above questions and one of the following applies to you then you
may want to complete this form.
• A guardian has cared for you because your parents were unable to provide proper care, but
your guardian was never declared a "legal guardian" by the court.
• Abandonment by both parents
• Your parents were physically or emotionally abusive toward you or your siblings.
• Your parents have substance abuse or other serious mental health problems AND do not
support you or your siblings.
Student Financial Aid Office
11400 Robinwood Drive
Hagerstown, MD 21742
finaid@hagerstowncc.edu
FAX: 301-791-9165
2019-2020
Dependency Appeal
Student Financial Aid Office
11400 Robinwood Drive
Hagerstown, MD 21742
Phone: 240-500-2473
finaid@hagerstowncc.edu
FAX: 301-791-9165
19CDEPAQ 1/11/2019
IMPORTANT NOTE: HCC’s Student Financial Aid Office cannot make students independent simply
because their parents can't afford to help. The standard financial need formula already evaluates each
family's financial resources and determines the family's ability to contribute toward the student's
educational expenses. If the financial resources are low enough, the student will show high financial
need. We also can't make students independent simply because their parents stop claiming them as
tax exemptions or choose not to help pay for college.
Yes No
Did your parents refuse to complete the FAFSA?
IF you answered yes above, will your parents sign the statement below?
If your parents signed the above statement, do not fill out the rest of the form. Complete
and sign the form on the last page and submit to HCC Financial Aid Office.
I refuse to complete the income information on my child’s Free Application for Federal Student Aid
(FAFSA), and I do not provide housing, food or insurance for my son/daughter. I further certify that I do
not and will not provide any financial support to my son/daughter. I understand that by refusing to supply
this information, I am limiting his/her eligibility for Federal Student Aid to student loan funds. He/She will
be ineligible for all free grant assistance: Federal Pell Grants, SEOG: Supplemental Education
Opportunity Grants, State Grants, etc.
Month and Year support ended ______________ or student’s age when support ended
__________ (year _______)
Parent’s Signature _________________________________________________ Date ___________
If your parent refuses to sign this statement, if possible provide supporting documentation verifying their
refusal to complete the FAFSA. (Example: copy of an e-mail, etc.)
Dependency Appeal Process
Complete the FAFSA application for 2019-2020 at www.fafsa.ed.gov.
The following documentation is needed to determine your dependency status:
Complete & Sign this Appeal Form.
2019-2020 Verification Worksheet
2019-2020 Student/Spouse Income Form
Typed statement explaining why you no longer live with your parents and explanation of
extenuating circumstances that you believe warrant review of your dependency. Be sure to
include your relationship with both of your parents (including contact frequency), and why you
cannot obtain information and/or support from your parents.
Unrelated third party statement of verification (see explanation on the last page of this form).
*Incomplete appeals will not be considered and will be returned*
19CDEPAQ 1/11/2019
Your current address: Street: ____________________________________________
City / State:_________________________________________
What is your state of legal residency? ______________________________________
Your parent’s current address: Street: _____________________________________
City / State: _________________________________
What is your parent’s state of legal residency? ________________________________
CHECK YES OR NO TO THE QUESTIONS BELOW:
Yes No
In the last twelve months did your parents pay your rent?
In the last twelve months did your parents pay your car insurance?
In the last twelve months did your parents provide health insurance for you?
In the last twelve months have your parents purchased your groceries?
In the last twelve months have your parents paid your utility bills?
Do you feel you pay all of you living expenses?
Did either of your parents claim you on their taxes?
You MUST attach: (use check box to be sure)
2019-2020 Verification Worksheet
2019-2020 Student/Spouse Income Form
Typed statement explaining why you no longer live with your parents and explanation of
extenuating circumstances that you believe warrant review of your dependency. Be sure to
include your relationship with both of your parents (including contact frequency), and why you
cannot obtain information and/or support from your parents.
Unrelated (not a relative) third party statement of verification on business or agency letterhead.
(See next page for help)
By signing this appeal form, I certify that all the information provided is complete and correct.
Student Signature: _____________________________________ Date: ___________________
19CDEPAQ 1/11/2019
Who qualifies as an unrelated third party? Who can write the statement of verification?
• A high school or local school district homeless liaison,
• A high school principal, guidance counselor, teacher, coach, school nurse, etc.,
• A medical professional, psychologist, psychiatrist, nurse, etc.,
• A therapist, social services case worker, pastor, etc.,
• The director of an emergency shelter program funded by the U.S. Department of Housing or
Urban Development or
• The director of a runaway or homeless youth center or transitional living program.
What should this person write? What should be included in a “statement of verification”?
• That depends on your special circumstances. This person is basically verifying that you do
not live with your parents and you do not receive support from your parents. Make sure that
the statement is printed on business or agency letterhead.
• They are also explaining why you no longer live with your parents. They are documenting:
o You were abused by your parents,
o That your parents are alcoholics or use drugs and do not support you,
o Your parents abandoned you and you do not know where they live or
o The severe circumstances that caused you to no longer live with your parents.
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2019-2020 Dependency Appeal 11400 Robinwood Drive Hagerstown, MD (Hagerstown Community College)

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Completed 20 August 2020

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