Financial Aid
937.328.6034 | | 570 East Leel Lane, Springfield, Ohio 45505
2020-2021 Dependency Appeal
Clark State Community College is required to consider parent information when determining
financial aid eligibility for students who are not independent according to the Free Application
for Federal Student Aid (FAFSA) definition. Exceptions to this requirement are made only when
adequate documentation of extenuating circumstances exist.
SECTION A: Student Information
Name____________________________________________ Student ID Number___________________
_____________________________ ______________________________ ___________ _____________
Street City State Zip
Home Phone _________________________________ Work Phone _____________________________
SECTION B: Appealable Circumstances
1. Severe circumstances within your family that prevent you from obtaining your parents’ financial
Contact severed due to physical or mental abuse
Parents have abandoned student
Parents are incarcerated or mentally/physically incapacitated
2. Death of a parent after filing the FAFSA and the surviving parent meets one of the conditions in
item #1 above.
3. You have extenuating circumstances not already described above which prevent any and all
contact with your parents in order to obtain parental information for FAFSA filing.
4. You have had an approved Dependency Appeal at Clark State Community College and are
applying for a renewal for the 2020-2021 academic year. Skip to SECTION D.
Appeals CAN NOT be considered for the following reasons:
You live on your own without parental financial support
You parents do not contribute or cannot aord to contribute to your college expenses
Your parents refuse to provide information for the FAFSA
Your parents no longer claim you on their taxes
SECTION C: Required Documentation
Submit the following:
1. Attach a detailed statement explaining the circumstances of your appeal. If your history includes
legal intervention, include the dates of those actions as well as the nature of those events.
2. Attach a notarized statement from an adult who can verify the family circumstances described in
your personal statement. The letter can be from a friend or family who can verify your situation.
3. Attach a signed letter on letterhead from an adult professional who is able to verify your situation
in their professional capacity and who is not personally connected to you. Adult professionals
Financial Aid
Financial Aid
937.328.6034 | | 570 East Leel Lane, Springfield, Ohio 45505
include clergy members, attorneys, school guidance counselors, medical doctors, mental health
professionals, teachers, professors, law enforcement ocers, professional sta of Children
Services Bureaus and other ocers 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 Oce:
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 arm that I have not knowingly or intentionally provided any
false or fraudulent documentation.
Student Signature ______________________________________________ Date __________________
For FA Oce use only.
Appeal approved? Yes No If not, why? _____________________________________
Signature of authorized school ocial ______________________________ Date _______________