2020-2021 Dependency Status Petition
INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED
Student’s Name:
ECC Student ID # or SSN:
__
Complete Address:
Email Address:
__
Telephone #:
Federal regulations require parents to have the primary responsibility to pay for a dependent student’s educational expenses.
None of the conditions listed below, singly or in combination, qualify as unusual circumstances meriting a dependency
override:
Parents refuse to contribute to the student’s education;
Parents are unwilling to provide information on the FAFSA or for verification;
Parents do not claim the student as a dependent for income tax purposes;
Student demonstrates total self-sufficiency.
ECC understands unusual circumstances occur and some students may have a unique family situation. This form is
used for reporting your unique situation when you are not able to obtain parental information. If you believe you have an
unusual or unique family situation, please complete this form and submit all required documents to the Financial Aid
Office. Please note, all decisions are made at the discretion and professional judgment of the ECC Financial Aid Office.
Submission of this form and supporting documents does not guarantee approval.
The law requires a determination of unusual circumstances for a dependency override be made each award year. A
decision made in one award year does not automatically mean a student would be deemed independent in another year.
Also, a dependency override performed at another school will not warrant a dependency override at ECC.
Students should be aware ECC is not required to perform dependency overrides, and if the financial aid administrator
determines an override is not appropriate, the decision cannot be appealed.
1) You are automatically considered to be independent and do not need to submit this form if any of the
following applies. If you answer No to all of these questions, proceed to #2:
Yes
No
Were you born before January 1, 1997?
Yes
No
As of today, are you married? “As of todayrefers to the day you sign your FAFSA.
Yes No
Are you currently serving on active duty in the U.S. Armed Forces for purposes other than training?
Yes No
Are you a veteran of the U.S. Armed Forces?
Yes No
Do you have children who will receive more than half of their support from you between July 1, 2020 & June
30, 2021?
Yes
No
Do you have dependents (other than your children or spouse) who live with you and who receive more than
half of their support from you, now and through June 30, 2021?
2021-2022 Dependency Status Petition
2) You may be independent if any of the following questions apply; however, you are required to submit the
required documentation to support your answer.
Yes
No
Are you or were you an emancipated minor as determined by a court in your
state of legal residence?
Provide court
documentation.
Yes
No
At any time since you turned age 13, were your biological parents deceased,
were you in foster care or were you a dependent or ward of the court?
Provide death certificates
for your parents; or,
provide court documents
regarding foster care &/or
status as a dependent or
ward of the court.
Yes
No
Are you or were you in legal guardianship as determined by a court in your
state of legal residence?
Provide court
documentation.
Yes
No
At any time on or after July 1, 2019, did your high school or school district
homeless liaison determine you were an unaccompanied youth who was
homeless or were self-supporting and at risk of being homeless?
Provide a letter from your
high school counselor or
school district homeless
liaison.
Yes
No
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 you were an unaccompanied youth who was
homeless or were self-supporting and at risk of being homeless?
Provide letter from the
director of the program.
Yes
No
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 you were an
unaccompanied youth who was homeless or were self-supporting and at risk of
being homeless?
Provide letter from the
director of the program.
3) Check the reason that best applies to your situation. I do not meet any of the criteria listed in #1 or #2, and
I am unable to provide my parents information on my 2020-2021 FAFSA because:
I have contact with my parents but my parents refuse to complete the FAFSA and do not and will not provide
me any financial support.
Please read next paragraph and submit required notarized statement from your parents with this
form; however, you do not need to answer #4 - # 6, nor do you have to submit documents requested
in #5. You will only be eligible for an unsubsidized loan at the dependent student grade level limit.
Your parents’ refusal to complete the FAFSA or their unwillingness to provide financial support does not
justify a dependency override. Your parents must write and sign a statement indicating they refuse to
provide you the information you need for your FAFSA and they do not and will not provide you any
financial support. The statement must include the date the support ended. The statement must be
notarized; you may use the Dependency Status Petition Reference Form for this.
Other - I have an unusual situation not listed above. Go to #4.
4) Check the reason that best describes your situation:
I have been separated from my parents due to an unsafe home environment.
I have been separated from my parents due to unusual circumstances and I live with a relative or friend who is
providing support, or live alone.
Since completing the 2020-2021 FAFSA, my marital status has changed from single to married. I am
requesting an update to my 2020-2021 FAFSA to reflect more accurately my ability to pay my educational
expenses:
o You must submit a copy of your marriage license. Also include all items listed in #5.
o You must add your spouse’s 2018 income information to your 2020-2021 FAFSA.
2019-2020 Dependency Status Petition
5) Submit the following information with this form:
o A detailed letter from you explaining the following, a) the unusual situation selected above; b) name and address
of both your parents; c) the last time you had contact with each of your parents when, where, and the nature of
the contact; d) how you have provided for yourself, or explain if someone else has supported you; and e) when
you started meeting your expenses without parental support.
o If selected for verification, provide all necessary documents for the Verification process, including but not
limited to: a copy of your 2018 Federal Tax Return Transcript (if filed) and W-2’s. If appealing due to becoming
married, a copy of your spouse’s 2018 Federal Tax
Return Transcript (if filed) and a copy of all W-2’s.
o Completed 2020-2021 Free Application for Federal Student Aid at www.FAFSA.gov. (ECC will process your
FAFSA if this appeal is approved. If this appeal is denied, you must resubmit the FAFSA with your parent(s)’
information.)
o Two (2) Dependency Status Petition Reference Forms. The Petition requires statements from at least TWO
references familiar with the family situation. At least one of the references must be from a third-party who is not a
family member. Examples of third-party references include: teachers, pastor/priest, guidance counselor, social
worker, mental health counselor, law enforcement official, and/or physician.
o A copy of your most recent cell phone bill. If unavailable, provide explanation including who pays for the cell
phone and what your relationship is to the person(s).
o A copy of your current lease agreement or mortgage statement. If unavailable, provide explanation including
where you live, who pays for the residence and utilities, and what your relationship is to the person(s).
o A copy of your proof of vehicle insurance. If unavailable, provide explanation including who pays for the
insurance and what your relationship is to the person(s).
6) Please check one:
This is my first dependency status review.
I am applying for a renewal of a previous dependency status review granted at ECC.
Your documents will be reviewed faster if they arrive as a group rather than one at a time – all documents should have your
name, SSN, and/or ECC Student ID # included. Please allow up to 20 business days for processing. Attach all supporting
documents to this form and submit in-person at the campus nearest you, or mail to:
East Central College, Financial Aid Office, 1964 Prairie Dell Road, Union, MO 63084 Or Fax to: (636) 583-6651
Or scan and email to: finaid@eastcentral.edu
Questions? Please call: (636) 584-6588
By signing this form, I agree to provide information will verify the accuracy of my information, if requested. If I purposely give false or
misleading information, I will be referred to the United States Department of Education’s Inspector General. If I purposely give false or
misleading information in order to qualify for Title IV funds, I may be fined $20,000, sent to prison, or both.
Student Signature:
Date:
School Certification:
OFFICE USE ONLY Approved Denied
FAO
Signature:
DATE:
Comments:
_
Date
Correction
submitted:
EFC:
click to sign
signature
click to edit
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signature
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2020-2021 Dependency Status Petition
Reference Form
Student Name:
Student ID#:
The student named above is submitting a Dependency Status Petition to the Financial Aid Office at East Central
College based on unusual family circumstance. These circumstances may include: unsafe home environment,
abuse, neglect, and/or abandonment.
Federal regulations require parents to have the primary responsibility to pay for a dependent student’s educational
expenses. None of the conditions listed below, singly or in combination, qualify as unusual circumstances
meriting a dependency override:
Parents refuse to contribute to the student’s education;
Parents are unwilling to provide information on the FAFSA or for verification;
Parents do not claim the student as a dependent for income tax purposes;
Student demonstrates total self-sufficiency.
The Petition requires statements from at least TWO references familiar with the family situation. At least one
of the references must be from a third-party who is not a family member. Examples of third-party references
include: teachers, pastor/priest, guidance counselor, social worker, mental health counselor, law enforcement
official, and/or physician.
In the space provided below and on the following page, please provide a detailed statement to corroborate the
student’s claims of unusual family circumstances. You must include: your relationship with this student, how
long you have known him/her, and any/all details about the student’s family situation. You may attach an
additional sheet, if necessary.
If a dependent student’s parents refuse to complete the FAFSA and are unwilling to provide financial support, but
the student cannot demonstrate an unusual family situation, the student may be eligible for an unsubsidized
student loan only. The parents must complete this form, explaining in the space below they refuse to complete
the FAFSA and refuse to provide any financial support, and must explain when the support ended. The form
must be notarized.
All references must complete and sign this form. A third-party reference may attach statement on official
letterhead instead of using space below; and, by doing so, will not require official notary public certification.
Otherwise, all references must have this document notarized.
Name of reference:
Telephone:
Relationship to student:
Occupation:
Email:
How long have you known student:
*Continue to page 2 for additional space for comments, signature and Notary Public certification*
click to sign
signature
click to edit
Dependency Status Petition Notarization Form, page 2
Student Name:
Student ID#:
(Use this space below for additional comments.)
By signing this form, I understand if I purposely give false or misleading information, the Dependency
Status Petition for the student named above may be denied and I will be referred to the United States
Department of Education’s Inspector General for further action.
Must be signed in the presence of an official notary public.
Reference Signature/Date:
TO BE COMPLETED BY AN OFFICIAL NOTARY PUBLIC
STATE OF , COUNTY OF ,
On this day of in the year _ , before me, the undersigned notary
public, personally appeared
, known to be the person whose
name is subscribed to the within instrument and acknowledged he/she executed the same for the purposes
therein contained.
In witness whereof, I hereunto set my hand and official seal.
Signature: , Notary Public
Printed Name:
Notary
Public in and for the State of
My
commission expires
.
Seal or Stamp
click to sign
signature
click to edit
click to sign
signature
click to edit
2020-2021 Dependency Status Petition
Reference Form
Student Name:
Student ID#:
The student named above is submitting a Dependency Status Petition to the Financial Aid Office at East Central
College based on unusual family circumstance. These circumstances may include: unsafe home environment,
abuse, neglect, and/or abandonment.
Federal regulations require parents to have the primary responsibility to pay for a dependent student’s educational
expenses. None of the conditions listed below, singly or in combination, qualify as unusual circumstances
meriting a dependency override:
Parents refuse to contribute to the student’s education;
Parents are unwilling to provide information on the FAFSA or for verification;
Parents do not claim the student as a dependent for income tax purposes;
Student demonstrates total self-sufficiency.
The Petition requires statements from at least TWO references familiar with the family situation. At least one
of the references must be from a third-party who is not a family member. Examples of third-party references
include: teachers, pastor/priest, guidance counselor, social worker, mental health counselor, law enforcement
official, and/or physician.
In the space provided below and on the following page, please provide a detailed statement to corroborate the
student’s claims of unusual family circumstances. You must include: your relationship with this student, how
long you have known him/her, and any/all details about the student’s family situation. You may attach an
additional sheet, if necessary.
If a dependent student’s parents refuse to complete the FAFSA and are unwilling to provide financial support, but
the student cannot demonstrate an unusual family situation, the student may be eligible for an unsubsidized
student loan only. The parents must complete this form, explaining in the space below they refuse to complete
the FAFSA and refuse to provide any financial support, and must explain when the support ended. The form
must be notarized.
All references must complete and sign this form. A third-party reference may attach statement on official
letterhead instead of using space below; and, by doing so, will not require official notary public certification.
Otherwise, all references must have this document notarized.
Name of reference:
Telephone:
Relationship to student:
Occupation:
Email:
How long have you known student:
*Continue to page 2 for additional space for comments, signature and Notary Public certification*
click to sign
signature
click to edit
Dependency Status Petition Notarization Form, page 2
Student Name:
Student ID#:
(Use this space below for additional comments.)
By signing this form, I understand if I purposely give false or misleading information, the Dependency
Status Petition for the student named above may be denied and I will be referred to the United States
Department of Education’s Inspector General for further action.
Must be signed in the presence of an official notary public.
Reference Signature/Date:
TO BE COMPLETED BY AN OFFICIAL NOTARY PUBLIC
STATE OF , COUNTY OF ,
On this day of in the year _ , before me, the undersigned notary
public, personally appeared
, known to be the person whose
name is subscribed to the within instrument and acknowledged he/she executed the same for the purposes
therein contained.
In witness whereof, I hereunto set my hand and official seal.
Signature: , Notary Public
Printed Name:
Notary
Public in and for the State of
My
commission expires
.
Seal or Stamp
click to sign
signature
click to edit
click to sign
signature
click to edit
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