Office of Financial Aid • 1420 N. Charles St. • Baltimore, MD 21201 • p: 410.837.4763 • f: 410.837.5493 • financialaid@ubalt.edu
Dependency Appeal Renewal Request Form
In order to consider a renewal appeal of your dependency status, the Office of Financial Aid must have documented proof
of the continuation of an extenuating circumstance that prevents the student from obtaining parental data for the FAFSA
form. The following information is required to document such a situation.
A. STUDENT INFORMATION
Last Name First Name M.I. Student ID Number (begins with 1 or 3)
Email Address Telephone Number Date of Birth
B. APPEAL CONTENTS
□ Your completed and signed 2019-2020 FAFSA.
□ A typed and signed one-page explanation of your current circumstance. Provide any update of the following:
• Your relationship with your biological and/or legally adoptive parents – include their first and last
names and when you last spoke with each parent.
• Specific dates of events cited in your statement.
• Where you currently live.
• How you are continuing to support yourself while living apart from your parents.
□ Copy of your 2017 tax transcript or use of the IRS Data Retrieval Tool on your FAFSA
□ All 2017 W-2 forms.
Please note: Students approved for a dependency override must request a review of their dependency status
each year until the student is automatically considered independent by federal criteria.
C. SIGN THIS WORKSHEET
By signing this worksheet, I (we) certify that all the information reported on this worksheet to qualify for federal student
aid is complete and correct. If you are dependent for financial aid purposes, at least one parent must sign. Warning: If you
purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.
______________________________ __________
Student’s signature Date
click to sign
signature
click to edit
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