(check
one)
___________________________________________
2018-2019
Confirmation of Dependency Status
Student ID___________________________________
____________________________________________ _______________________________________
Last Name First Name
According to our records, you indicated on the 2018-2019 Free Application for Federal Student Aid (FAFSA) that you are an independent student
because you met one of the following criteria. Please submit supporting documentation required for the selected criteria to Pasadena City College’s
Office of Financial Aid as indicated below:
Independent Status Eligibility
Criteria
Supporting Documentation Required
At some point since you turned 13, both your parents
(biological or adoptive) were deceased, even if you are now adopted
Copy of parents’ death certificate(s)
At some point since you turned 13, you were in foster care,
even if you are no
longer in foster care today
Copy of official documentation from the court
confirming your status in
foster care
At some point since you turned 13, you were a dependent/ward of the court,
which means the court
determined that your parent(s) were unable to care for
you and that the State or the court took legal custody of you, even if you are
now adopted.
Copy of official documentation from the court confirming your status as
a dependent/ward of
the court.
At the time you completed the FAFSA, you were an emancipated minor or you
were an emancipated minor
immediately before you reached age of being an
adult in your state.
Copy of the emancipation documentation from the court confirming your
status and the effective
date(s) of the status
At the time you completed the FAFSA, you were in a court
ordered legal
guardianship or you were in a court ordered legal guardianship immediately
before you reached age of being an adult in your state
Copy of the court documentation confirming your
status in a legal
guardianship and the effective date(s) of that legal guardianship status
At any time on or after July 1, 2017, you received a
determination from your
high
school or school district homeless liaison that you were an unaccompanied
youth who was homeless
Copy of the determination documentation from
the high school or school
district homeless liaison confirming this status
At any time on or after July 1, 2017, you received a
determination from the
director of an emergency shelter or transitional housing program funded by the
U.S. Department of Housing and Urban Development (HUD) that you were an
unaccompanied youth who was homeless
Copy of the determination documentation from
the director of an
emergency shelter or transitional housing program funded by the U.S.
Department of Housing and Urban Development confirming this status
At any time on or after July 1, 2017, you received a
determination from the
director of a runaway or homeless youth basic center or transitional living
program that you were an unaccompanied youth who was homeless or were
self- supporting and at risk of being homeless
Copy of the determination documentation
determination from
the director of a runaway or homeless youth basic center or
transitional living program confirming this status
If none of the above apply please contact the Office of Financial Aid for more information and instructions regarding your FAFSA.
I understand that by singing this form I agree, if asked, to provide information that will verify the accuracy of the completed form. Also, I certify that I understand that
Pasadena City College’s Office of Financial Aid has the authority to verify information reported on this form with other federal and state agencies. I further
understand that if I purposely give false or misleading information, I may be fined up to $20,000, sent to prison or both.
__________________________________________________________
Student Signature Date
1570 East Colorado Blvd.L-114, Pasadena, California 91106
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2003 19DPST
