Option 1: New Petition for Independent Status
Attach a typed, signed statement (written by you) describing your circumstances. Include the
following:
a. A description of where and with whom you are living, and how long you have lived at this
location.
b. If you are estranged from your parents, please describe the nature and cause of the
estrangement and when this occurred.
c. When, where, and under what circumstances did you last have contact with your parent(s).
d. An explanation of how you have been supported, or have supported yourself, and for how
long. Statements explaining that you support yourself are not sufficient to meet the
requirement for independent status.
Attach at least 2 typed, signed statements from adults who are aware of your situation and can
verify your statement. At least one of these statements must be from someone in a professional
capacity (such as a teacher, counselor or clergy member).
a. Statements must include their name, job title, address, contact phone number, relationship
to you, how long they have known you, and in what capacity.
b. Statements should include information concerning why you have no contact with both
parents and the last time you had contact with them. Statements explaining that you
support yourself are not sufficient to meet the requirement for independent status.
Provide supporting documentation (if available) which may include, but is not limited to:
documents confirming parent is deceased, incarcerated or institutionalized, court documents
confirming that there is a protection/restraining order that prohibits contact with the parent(s).
Copies of official court documents are also acceptable.
Sign and submit this petition form and all of the required documents.
Option 2: Renewal Petition for Independent Status (must have had a 18-19 petition approved)
Attach a typed, signed statement (written by you) describing your circumstances. Include the
following:
a. A description of where and with whom you are living, and how long you have lived at this
location.
b. If you are estranged from your parents, please describe the nature and cause of the
estrangement and when this occurred.
c. When, where, and under what circumstances you last had contact with your parent(s).
d. An explanation of how you have been supported, or have supported yourself, and for how
long. Statements explaining that you support yourself are not sufficient to meet the
requirement for independent status.
e. Describe any changes that have occurred since you last submitted your Petition for
Independent Status.
If any changes have occurred since you last submitted your Petition for Independent Status, provide
any documentation to support the change(s).
Sign and submit this petition form with all required documents.
Certification
I certify that the facts presented within this petition are true and correct. I understand that providing false or misleading
information could result in fines, imprisonment and/or a repayment of all aid received.
Signature Date
