937.328.6034 | ﬁnancialaid@clarkstate.edu | 570 East Leel Lane, Springﬁeld, Ohio 45505
include clergy members, attorneys, school guidance counselors, medical doctors, mental health
professionals, teachers, professors, law enforcement ocers, professional sta of Children
Services Bureaus and other ocers of the court. Court documentation (applicable to the situation
described) may be considered of a statement from an adult professional.
4. If you are submitting an appeal due to a death of a parent, attach a copy of the death certiﬁcate.
5. If you are submitting an appeal due to incarceration, attach proof of parent’s incarceration.
6. If you are submitting an appeal due to parental incapacitation, attach a letter from the parent’s
doctor explaining the parent’s condition.
NOTE: All letters should explain the situation in detail. If you do not submit all of the required
documentation or the documents do not adequately explain your situation, your appeal may be
considered incomplete or may be denied.
SECTION D: Dependency Appeal Renewal
Follow the steps below if you have had an approved 2018/2019 or 2019/2020 Dependency Appeal at
Clark State Community College.
1. Submit your 2020-2021 FAFSA. When you submit your FAFSA on-line, you will likely answer “No”
to all the questions in the “Dependency Determination” section. Then in the “Special Circumstance”
section, indicate that you are “unable to provide parent information.” Do not provide any parent
data, and “acknowledge that your FAFSA will be submitted without calculating an EFC.
2. Submit to the Financial Aid Oce:
a. A signed personal statement certifying that the condition under which you previously appealed
remain the same.
b. Required veriﬁcation documents if your 2020/2021 FAFSA was selected for veriﬁcation. See your
Financial Aid Self-Service portal for required documents.
SECTION E: Veriﬁcation
If your 2020-2021 FAFSA is selected for veriﬁcation, you will be notiﬁed through your student email of
documents you need to submit for the veriﬁcation process.
SECTION F: Certiﬁcation Statement
I certify that all of the information on this form and accompanying documents are true and complete to
the best of my knowledge. Furthermore, I arm that I have not knowingly or intentionally provided any
false or fraudulent documentation.
Student Signature ______________________________________________ Date __________________
For FA Oce use only.
Appeal approved? Yes No If not, why? _____________________________________
Signature of authorized school ocial ______________________________ Date _______________