Rev. 2/2020
Indian River State College
2020-2021 Dependency Override Form
Office of Financial Aid3209 Virginia Avenue Fort Pierce, FL 34981 (772) 462-7450
STUDENT NAME: IRSC STUDENT ID:
HOME NUMBER: WORK NUMBER: DATE OF BIRTH:
ADDRESS:
STREET ADDRESS CITY STATE ZIP CODE
You have indicated on your FAFSA, you either meet a criteria listed below, or are unable to provide parental
information. Please mark the applicable circumstance, and provide the documentation listed below:
At any time since you turned age 13, were both your parents deceased, were you in foster care or were
you a dependent or ward of the court? If so, please submit:
Death Certificate for deceased parent(s)
Documentation showing you were in foster care
Documentation showing you were a ward of the court
As determined by a court in your state of legal residence, are you or were you an emancipated minor? If
so, please submit:
Court documentation showing you were declared an emancipated minor
Does someone other than your parent or stepparent have legal guardianship of you, as determined by a
court in your state of legal residence? If so, please submit:
Submit proof of legal guardianship
At any time or after July 1, 2019, did your high school or school district homeless liaison determine that
you were an unaccompanied youth who was homeless or were self-supporting and at risk for being
homeless? If so, please submit:
Proof of homelessness as determined by the high school/school district
At any time on or after July 1, 2019, did the director of an emergency shelter or transitional housing
program funded by the U.S. Department of Housing and Urban Development determine that you were
an unaccompanied youth who was homeless or were self-supporting and at risk of being homeless? If
so, please submit:
Proof of homelessness as determined by HUD
At any time on or after July 1, 2019, did the director of a runaway or homeless youth basic center or
transitional living program determine that you were an unaccompanied youth who was homeless or were
self-supporting and at risk of being homeless? If so, please submit:
Proof of homelessness as determined by transitional living program
Student’s Name: IRSC ID:
Rev. 2/2020
Potential Circumstances Continued:
At any time on or after July 1, 2019, did the director of a runaway or homeless youth basic center or
transitional living program determine that you were an unaccompanied youth who was homeless or were
self-supporting and at risk of being homeless? If so, please submit:
Proof of homelessness as determined by transitional living program
I have extenuating circumstances that are not listed above. Please briefly explain your situation below.
If your situation is determined to be extenuating (according to Federal guidelines), you will be required
to provide additional documentation.
CERTIFICATION
I understand that submission of a Dependency Override Form to the Financial Aid Office does not guarantee I
will be declared an independent student and no approval will be considered without documentation. I
understand this information must be review and approved by the Director of Financial Aid. By signing this
application, I certify that the information on this form and contained within the supporting documentation is true,
correct and complete to the best of my/our knowledge.
Student’s Signature Date
UPLOAD ALL DOCUMENTS TO YOUR MYPIONEER PORTAL (under the dependency documents link if the
link is unavailable, drop off to your nearest campus
FOR OFFICE USE ONLY:
Review Date ___________ Reviewed By ___________ Approve Deny Cancel Request
IRSC is an EA/EO educational institution.
click to sign
signature
click to edit
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome