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Office of Financial Aid & Scholarships
Gonzales-Westside-Reserve- Campuses
Financialaid@rpcc.edu
2020-2021 Dependency Override Request
(Note: Incomplete dependency override requests will NOT be accepted)
Student Name: ______________________________________________ Student ID#:_____________________________________
Student Mailing Address: __________________________________ ___ Telephone Number:_______________________________
Email Address: ______________________________________________________________________________________________
Under Federal law your family is primarily responsible for paying for your college expenses. In very limited situations, Federal law
may allow us to consider a dependent student as independent (for financial aid purposes) when unusual conditions exist.
Examples of unusual conditions where you may be unable to provide parental data include:
Your parents are incarcerated; or
You have left home due to an abusive family environment; or
You do not know your parents location, are unable to contact them, and you are not adopted.
The following DO NOT qualify as reasons for requesting a dependency change:
You do not live with your parents or you are self-sufficient; or
Your parents refuse to contribute to your college expenses; or
Your parents do not want to provide their information on your FAFSA; or
Your parents do not claim you (the student) as an exemption on their income taxes.
** Verification of your FAFSA information must be completed before adjustments can be made. Check your eligibility
requirements on your LoLA account to see which documents are required for verification, in addition to any request for additional
information.
Select the reason for your Dependency Override Request:
If any of the following applies to your situation, please indicate below with a check mark. We will need to receive ALL listed
information below before the request can be considered.
Death of custodial parent and no contact with non-custodial parent.
Required Documentation:
Typed and signed personal statement outlining the reason for an request, including specific information and dates
Copy of student’s birth certificate
2020-2021 Household Verification Form
2018 IRS Federal Income Tax Return Transcript
Copy of death certificates or obituaries
At least two signed letters from third party (non-family member) who can verify your situation from personal
knowledge. Professional references must be signed and listed on agency letterhead (law enforcement, guidance
counselor, social worker, clergy, etc.) Personal references (family member) must be signed and notarized.
I no longer live with my parent(s) due to an unsafe home environment. (This may be due to physical or emotional abuse, as
well as any drug or alcohol abuse.) Required Documentation:
Typed and signed personal statement outlining the reason for an request, including specific information and dates
Copy of student’s birth certificate
2020-2021 Household Verification Form
2018 IRS Federal Income Tax Return Transcript
At least two signed letters from third party (non-family member) who can verify your situation from personal
knowledge. Professional references must be signed and listed on agency letterhead (law enforcement, guidance
counselor, social worker, clergy, etc.) Personal references (family member) must be signed and notarized.
Currently not living with parent(s). (This may be due to severe estrangement, abandonment, incarceration, or mental
incapacity.)
Required Documentation:
Typed and signed personal statement outlining the reason for an request, including specific information and dates
Copy of student’s birth certificate
2020-2021 Household Verification Form
2018 IRS Federal Tax Return Transcript
At least two signed letters from third party (non-family member) who can verify your situation from personal
knowledge. Professional references must be signed and listed on agency letterhead (law enforcement, guidance
counselor, social worker, clergy, etc.) Personal references (family member) must be signed and notarized.
Certification Statement
By signing this form, I certify that all of the information on this form and any attachments are complete and accurate to the best of
my knowledge. Warning: Purposely giving false or misleading information may result in a fine, imprisonment, or both.
Student Signature _____________
Date ____________
TO BE COMPLETED BY FINANCIAL AID SCHOOL OFFICIAL
Approved:________ Denied:_________
Comments:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Printed Name of School Official: __________________________________ Title: __________________________________
Signature of School Official: ______________________________________________________________________________
Date: ____________________________________
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