Lorain County Community College Financial Services 1005 N. Abbe Rd, Elyria, OH 44035 Phone: 440-366-4034
Dependency Appeal Request
2020-21 Financial Aid Year
Last Name First Name Middle Initial
LCCC Student ID #
Under federal guidelines, most traditional-age undergraduate students are automatically considered dependent upon their parents. However, a
student may have extenuating circumstances that warrant special consideration for independent status.
Extenuating circumstances include, but are not limited to, estrangement, abuse, abandonment, or other irreconcilable differences that are properly
Extenuating circumstances do not include any of the following situations: self-sufficiency, parent(s) refusal to complete the FAFSA or provide
required documents, student's refusal to request information from parent(s), student is not claimed as an exemption by parent(s) for federal
income tax purposes, or parent(s) refusal or inability to provide financial support for college expenses.
Section A. Letters of Explanation/Support. This form must be accompanied by the following:
First-time request at Lorain County Community College:
A signed and detailed letter from you, the student, explaining the extenuating circumstance, including your relationship with both
biological/adoptive parents.
2-3 separate letters from independent third party sources (ie. counselor, medical authority, clergy, court, government agency) who can
attest first-hand to the extenuating circumstances. These letters must be signed and detailed with as much information about the
situation as possible.
Request for renewal for previously approved dependency appeal at Lorain County Community College:
A new, signed statement indicating your current relationship status with your biological/adoptive parents.
Section B: Financial Documentation. ALL documentation is required before your request can be reviewed.
Your 2018 Federal Tax Return (signed 1040 form), Tax Return Transcript (free from the IRS), or successful use of the IRS Data Retrieval
Tool (See www.lorainccc.edu/finaidapply for guidance)
If you did not file a 2018 Federal Tax Return, submit copies of your 2018 W-2(s). Please note: you may be asked to submit additional
verification of your non-tax filing status.
If you did not work/are not working, provide a statement about how you are supported (expenses such as phone, medical, car, etc.) and
by whom those expenses are paid. Include a statement that you did not/were not required to file a tax return in 2018.
Section C: Other People
Are you providing/will you provide more than 50% of the support for anyone else from 7/1/20 6/30/21?
No Yes If yes, indicate name(s), age(s), and relationship(s) to you:___________________________________________
Section D: Certification
I certify that all of the information reported is complete and accurate. Warning: If you purposely give false or misleading information on this form,
you may be fined, sentenced to jail, or both. Electronic signatures will not be accepted.
Student signature: Date:
When all required documents have been gathered, you may submit your information by: a) mail to the address below; b) fax to 440-366-4634 or; c)
deliver to Financial Services, First Floor, Bass Library. Please note: Your request may not be approved nor result in an increase of your financial aid
eligibility. You will be notified of the result of your request via email sent to your official LCCC email address. Watch for two-sided documents. Be
sure to include both sides when faxing. Do not email any documents with personally identifiable information.