Haskell Indian Nations University Phone: (785) 749-8468
Financial Aid Office Fax: (785) 832-6617
155 Indian Avenue, Box 5027
Lawrence, KS 66046
2020-2021
Appeal for Dependency Override
RETURN THIS FORM IN PEN AND SUBMIT WITH ALL APPLICABLED DOCUMENTATION
Student’s Name: ___________________________________________ Student’s ID#:_______________________
Phone Number: __________________________________________ Date of Birth: ________________________
Federal regulations (Public Law 102-325, Sec. 480 (d) require that the Financial Aid Officer consider parent
information and expect parent contribution for students unless the student meets one of the following
conditions:
1. Is 24 years old or older by December 31 of the current award year,
2. Is married as of the date he/she applies,
3. Is currently serving on active duty for purposes other than training,
4. Is a veteran of the U.S. Armed Forces,
5. Has children and/or dependents other than a spouse who will receive more than half of their support
from you during the award year,
6. At any time since you turned age 13, both parents were deceased, was in foster care or was a ward of
the court,
7. Is an emancipated minor or is was in legal guardianship as determined by a court in your state of legal
residence,
8. Was determined at any time since July 1, 2019, to be an unaccompanied youth who was homeless or
self-supporting, and at risk of being homeless as determined by:
a. Your high school or school district homeless liaison,
b. The director of an emergency shelter or transitional housing program funded by the U.S.
department of Housing and Urban Development, or
c. The director of a runaway or homeless youth basic center or transitional living program.
The parent’s unwillingness (versus inability) or refusal to assist the student cannot
be grounds for a dependency
override. The Financial Aid Office may be able to override your dependent status only if unusual circumstances
existed that made it impossible for you to have reasonable contact with your parents. If your family situation
involves extenuating circumstances sufficiently documented, you may request a review of your dependency
status by submitting:
1. A personal statement describing the relationship between you and your parents and the specific reasons
you are unable to secure their cooperation in completing the parent information section of your Free
Application for Federal Student Aid (FAFSA). Form is on second page of the documents.
2. At least one statement on the Third Party Professional Documentation form (see attachement). A third
party source who can document, verify and support your situation (e.g. social workers, counselors,
clergy members or teacher). See Third Party Professional documentation for Dependency Override.
Haskell Indian Nations University Phone: (785) 749-8468
Financial Aid Office Fax: (785) 832-6617
155 Indian Avenue, Box 5027
Lawrence, KS 66046
CIRCUMSTANCES AND PERSONAL STATEMENT
When was the last time you lived with your parent(s)? Month/Year ___________________
When was the last time you had any contact with your parent(s)? Month/Year _______________
When did your parent(s) last provide any form of financial support? Month/Year _______________
Please attach additional sheets if space is needed for any of the questions below.
As clearly as possible, explain your present living arrangements.
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
How do you financially support yourself and your living expenses?
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Please explain and provide documentation for your exceptional circumstance(s). Be sure to describe in detail the
relationship between you and your parents.
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
CERTIFICATION
I certify that the information I have provided regarding my request is true, complete and accurate to the best of
my knowledge. I understand this information will be used to document my request for a dependency override
and submit corrections to my FAFSA. By signing this application I agree, if asked to provide information that will
verify the accuracy of my request. I understand that if I purposely give false or misleading information in
correction with my application for federal student aid, I may be fined, set to prison or both.
I understand that if I move back with my parent(s) or received any kind of parental support, I must report this to
the office of Financial Aid immediately.
_____________________________________________________ _________________________
Student Signature Date
FOR OFFICE USE ONLY
Dependency Override Outcome: Semester__________ Denied__________ Approved ____________
Financial Aid Officer Signature _____________________________________ Date_______________
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