Fillable 2020-2021 Financial Aid Office Request for Dependency Override (El Paso Community College)

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2020-2021 Financial Aid Office Request for Dependency Override (El Paso Community College)

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The 2020-2021 Financial Aid Office Request for Dependency Override (El Paso Community College) form is 6 pages long and contains:

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  • 18 check-boxes
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"The El Paso County Community College District does not discriminate on the basis of race, color, national origin, religion, gender, age, disability,
veteran sexual orientation, or gender identity status, "
Page 1 Rev. 03/02/2020
2020-2021
Financial Aid Office
Request for Dependency Override
First Name: ___________________ Last Name: ____________________ EPCC ID: _______________
A Dependency Override constitutes any unusual circumstances forcing a dependent student to become an
independent student. Complete this form and provide all the documentation requested. Submission of this
appeal and documentation does not necessarily mean the petition will be approved each determination is
made on a case by case basis. The Financial Aid Office decision is final and cannot be appealed to the
Department of Education.
Unusual circumstances constitute:
Unique or unusual family circumstances include family abuse or neglect.
Parental desertion and other situations where contact between the student and parent is non-
existent.
The Financial Aid Office has the authority to determine what circumstances cannot be considered
unusual.
REQUIRED DOCUMENTS
Student Statement
A letter explaining in detailing the exceptional circumstances making you
independent due to your current relationship with your parents. The letter must
specify when you last had contact with them, why you cannot obtain
information and support from them. Finally, state how you have been
supporting yourself.
Supporting
Documentation
Provide supporting documentation attesting to the circumstances described in
your statement. Additional documentation may be required.
Notarized
Statements
Two different notarized statements from professionals aware of your
circumstances such as teachers, counselor, clergy, social worker, etc. (Refer to
page 3 and 4.)
Benefits Statement
Letter from Health and Human Services Commission if you are receiving Food
Stamps/SNAP benefits.
Tax Forms
2018 and 2019 IRS Tax Transcripts if you are required to file.
2018 and 2019 Non-filer Letters if you are not required to file.
Financial Aid Form
Complete the 2020-2021 Institutional Verification Form, found at:
https://www.epcc.edu/Admissions/FinancialAid/financial-aid-forms
"The El Paso County Community College District does not discriminate on the basis of race, color, national origin, religion, gender, age, disability,
veteran sexual orientation, or gender identity status, "
Page 2 Rev. 03/02/2020
First Name: ___________________ Last Name: ____________________ EPCC ID: _______________
DEPENDENCY OVERRIDE
Please answer the following, if additional space is needed attach a separate sheet.
1. Did you live with either parent during 2019?
No Yes
If Yes, what was the last day that you lived with them? _____/_____/_____
2. Do you receive or have you received financial support from your parents in the past year (such as monetary
gifts, payments of bills, cash for expenses, etc.)?
No Yes
Indicate the amount and type of support for 2019 ______________________________
When did you stop receiving support? _____/_____/_____
3. Did your parents file a 2019 Federal Tax Return?
No Yes
If Yes, provide 2019 IRS Tax Transcripts or attach a separate page stating the reason
you cannot.
4. Did you file a 2019 Federal Tax Return?
Yes No
If No, why not? _________________________________________________________
5. Did anyone besides yourself claim you as a TAX EXEMPTION on their 2019 Federal Tax Return?
No Yes
If Yes, provide their 2019 IRS Tax Transcripts.
6. My current permanent address is: ___________________________________________________________
7. I have lived at this address since: _____/_____/_____
8. This property is owned by: __________________________________________________________________
9. Does a relative own the residence listed above?
No Yes, How are you related? ________________
"The El Paso County Community College District does not discriminate on the basis of race, color, national origin, religion, gender, age, disability,
veteran sexual orientation, or gender identity status, "
Page 3 Rev. 03/02/2020
First Name: ___________________ Last Name: ____________________ EPCC ID: _______________
INCOME AND EXPENSES
CERTIFICATION
All of the information on this form is true and complete to the best of my knowledge. If asked by an authorized official,
I agree to give proof of the information provided on this form. Proof may include a copy of my U.S. income tax return
or IRS Tax Transcript. I understand if I do not give proof when asked, my student file may not be processed for financial
aid.
________________________________ _____________________
Student Signature Date
2019 INCOME
Taxable Income (wages, interest income, etc.)
Yearly Amount
*Income from Work
$
*Other Taxable Income
$
*Unemployment Benefits
$
Untaxed Income and Benefits
*Social Security Benefits
$
*Aid to Families with Dependent Children (AFDC or ADC
$
*Other Untaxed Income and Benefits (child support, etc.)
$
TOTAL YEARLY INCOME
$
MONTHLY EXPENSES
Monthly Amount Provided By:
Housing
$
Utilities
$
Food
$
Transportation (Gas and car maintenane)
$
Car Payment
$
TOTAL MONTHLY EXPENSES
$
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"The El Paso County Community College District does not discriminate on the basis of race, color, national origin, religion, gender, age, disability,
veteran sexual orientation, or gender identity status, "
Page 4 Rev. 03/02/2020
REFERENCE
1. How long have you known the student? _________________________
2. Are you related to the student?
No Yes, how? _______________________________________________________________________
3. With whom does the student reside? ___________________________________________________________________
4. To the best of your knowledge has anyone claimed the student as an income tax exemption for the following years:
2018
Do not know No Yes, by whom____________________________
2019
Do not know No Yes, by whom____________________________
5. Please explain briefly what you know to be the student’s situation and if you are providing support of any kind. If you
should need more space to explain, please attach a letter.
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
I certify that all of the information on this form is true and completed to the best of my knowledge. I also understand that I may be
contacted if further information is needed.
_________________________________ ________________________________________
Name of Reference (please print) Official Title or Relationship to Student
_________________________________ _________________________________________
Signature Telephone Number
_________________________________ __________________________________________
Street Address, P.O. Box, Etc. Best Time to be Reached
_________________________________ __________________________________________
City, State, and Zip
Date
ACKNOWLEDGMENT
STATE OF __________________)
) SS.________________
COUNTY OF ________________)
On this _______day of _____________20______, before me, the undersigned Notary Public, personally appeared
____________________________________ to me known to be the individuals(s) described in and who executed the foregoing
instrument, and acknowledged that he (she) (they) executed the same as his (her) (their) free act and deed.
My Commission expires _____________________________ ________________________________
Notary Public
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signature
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"The El Paso County Community College District does not discriminate on the basis of race, color, national origin, religion, gender, age, disability,
veteran sexual orientation, or gender identity status, "
Page 5 Rev. 03/02/2020
REFERENCE
6. How long have you known the student? _________________________
7. Are you related to the student?
No Yes, how? _______________________________________________________________________
8. With whom does the student reside? ___________________________________________________________________
9. To the best of your knowledge has anyone claimed the student as an income tax exemption for the following years:
2018
Do not know No Yes, by whom____________________________
2019
Do not know No Yes, by whom____________________________
10. Please explain briefly what you know to be the student’s situation and if you are providing support of any kind. If you
should need more space to explain, please attach a letter.
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
I certify that all of the information on this form is true and completed to the best of my knowledge. I also understand that I may be
contacted if further information is needed.
_________________________________ ________________________________________
Name of Reference (please print) Official Title or Relationship to Student
_________________________________ _________________________________________
Signature Telephone Number
_________________________________ __________________________________________
Street Address, P.O. Box, Etc. Best Time to be Reached
_________________________________ __________________________________________
City, State, and Zip Date
ACKNOWLEDGMENT
STATE OF __________________)
) SS.________________
COUNTY OF ________________)
On this _______day of _____________20______, before me, the undersigned Notary Public, personally appeared
____________________________________ to me known to be the individuals(s) described in and who executed the foregoing
instrument, and acknowledged that he (she) (they) executed the same as his (her) (their) free act and deed.
My Commission expires _____________________________ ________________________________
Notary Public
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signature
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"The El Paso County Community College District does not discriminate on the basis of race, color, national origin, religion, gender, age, disability,
veteran sexual orientation, or gender identity status, "
Page 6 Rev. 03/02/2020
FINANCIAL AID STAFF CERTIFICATION
Describe in detail specific unusual circumstances upon which the determination is to grant or deny the
dependency override:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
INITIAL REQUEST
_________________________ ___________________________ _________________
Staff Name Staff Signature Date
Comments: ___________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
SECONDARY REVIEW
_________________________ ___________________________ _________________
Staff Name Staff Signature Date
Comments: ___________________________________________________________________________________
_____________________________________________________________________________________
Action taken: ____________________________________________
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2020-2021 Financial Aid Office Request for Dependency Override (El Paso Community College)

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Completed 8 January 2021

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