Fillable 2021-2022 Dependency Override Appeal (University of Wisconsin - Whitewater)

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2021-2022 Dependency Override Appeal (University of Wisconsin - Whitewater)

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800 West Main Street
Whitewater, WI 53190
www.uww.edu/financialaid
p 262-472-1130 f 262-472-5655
uwwfao@uww.edu
P
age 1 of 3
2021-2022 Dependency Override Appeal
The US Department of Education does allow financial aid administrators to use professional judgment in cases where
extenuating circumstances prevent a student from being able to provide parental information on the Free Application
for Federal Student Aid (FAFSA), commonly referred to as a dependency override or appeal.
The following are situations, in and of themselves, would not be considered a special circumstance for dependency
status appeal:
1. Your parents do not claim you as a dependent on their income taxes.
2. You do not live with your parents and/or you and your parents are having a disagreement.
3. Your parents refuse to provide their information on your FAFSA.
4. Your parents do not contribute to your college expenses and/or you are self-supporting.
If all four above apply to you, you do not qualify for dependency appeal/override consideration and must update
your 2021-2022 FAFSA at www.fafsa.gov with parental information and the signature of at least one parent
.
In
very limited cases, an otherwise dependent student may be able to submit the FAFSA without parental information
due to special circumstances, including:
• Your parents are incarcerated; or
• You have left home due to an abusive family environment; or
• You do not know where your parents are, are unable to contact them, and you have not been adopted.
I
nstructions: Return the completed form with the required documentation to the Financial Aid Office after completing
the FAFSA. Decisions made at other institutions are not accepted. All documentation received by our office will be kept
confidential. All decisions made by the UW-Whitewater Financial Aid Office are FINAL and not appealable.
Student Name: Student ID#:
Last First MI
Home Address: Phone:
Street City State ZIP Code
D
ependency Override Appeal Process:
1. Personal Statement: On a separate sheet of paper, tell us in your own words why you are requesting a
dependency override by outlining the mitigating circumstances and why you should be considered independent,
including your current living situation and how you are supporting yourself.
Be sure to describe the following: (1) The nature of your relationship with your parents; (2) the location of both
parents and when you last had contact with them; and (3) why you cannot obtain information and/or support
from your parents. Sign and date your statement. You will need to submit a personal statement with an update
of your situation every year.
800 West Main Street
Whitewater, WI 53190
www.uww.edu/financialaid
p 262-472-1130 f 262-472-5655
uwwfao@uww.edu
P
age 2 of 3
2. Third-Party Statements: Provide at least two letters from third-party adult individuals who personally have
knowledge of your situation and who can verify your circumstances. At least one letter (on letterhead) must be from
an individual who has been involved in the circumstances in a professional capacity (high school guidance counselor,
clergy, social worker/caseworker, counselor/therapist, doctor, attorney, teacher/professor, university administrator,
supervisor/employer).
A
ll letters must include details such as:
• The length of time and nature of the writer’s relationship to you and his/her knowledge of your situation
• The reason why you cannot provide your parents’ information on the FAFSA/why you should be
independent
• The writer’s name, address, telephone number, and signature
3. Copy of 2019 signed Federal Tax Return and 2019 W-2 Forms. If you did not file and are not required to file, list
below your employer(s) and any income received in 2019 (attach your W-2 or 1099 forms).
List each 2019 employer/source of income: 2019 Amount received:
4. Expenses: Place an X in the appropriate boxes.
Di
d anyone claim you as an exemption on their 2019 federal tax return?
☐ Yes ☐ No ☐Don’t Know
If yes: Person’s Name:
Relationship to the Student:
D
id anyone provide your health insurance within the last year?
☐ Yes ☐ No ☐Don’t Know
If yes: Person’s Name:
Relationship to the Student:
Di
d anyone provide your auto insurance within the last year?
☐ Yes ☐ No ☐Don’t Know
If yes: Person’s Name:
Relationship to the Student:
800 West Main Street
Whitewater, WI 53190
www.uww.edu/financialaid
p 262-472-1130 f 262-472-5655
uwwfao@uww.edu
P
age 3 of 3
Upon receipt of your documentation, it may be necessary to request additional information to clarify or
supplement information already submitted. You will be notified if additional documentation is needed.
Signature/Certification
By signing this worksheet, I certify that all the information reported on it is complete and correct. If you
purposely give false or misleading information on this worksheet, you may be fined, sentenced to jail, or both.
Note: We may request additional documentation if we have reason to believe any of the information on this
form is inaccurate.
Signature of Applicant Date
Submit form to:
For Office Use Only
T
his form is being provided due to:
Approved
Denied
Authorized By:
Date:
Processed By:
Date:
UW-Whitewater Financial Aid Office
Hyer Hall 130
800 West Main Street,
Whitewater, WI 53190 or fax to (262) 472-5655
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2021-2022 Dependency Override Appeal (University of Wisconsin - Whitewater)

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Completed 21 August 2021

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