Office Use Only Dependency Override: _____Approved _____Denied
Comments_________________________________________________________________________________________
_________________________________________________________________________________________________
Approved by:__________________________________________________________ Date ____________________
2018-2019
Dependency Override Request
Student ID _______________________
________________________________________________ ______________________________________ ______
Last Name First Name M.I.
In unusual circumstances, financial aid administrators are given the authority, under Section 480(d)(1)(I) of the Higher Education Act,
to determine that a student is independent, this is a dependency override.
Situations that might
warrant a dependency override
:
•
The student’s voluntary or involuntary removal from the parent’s home due to an abusive or harmful situation that
threatened the student’s safety and/or health
•
The student’s abandonment by the parent(s)
•
The inability of the student to locate the parent(s)
Several conditions that
do not qualify
as unusual circumstances are:
•
Individually or combination of parents refusal to contribute to the student’s education
•
Parent’s unwillingness to provide documents and information to complete the student’s application for aid
•
Parents do not claim the student on their Income taxes as a dependent
•
Parent living in another state or country
•
A student who demonstrates self
---
sufficiency
To request a Dependency Override (which must be done annually even if the prior award year's request was approved), a
student who meets the conditions stated above must attach the following statements to this fo
rm:
1. A signed and dated statement from the student detailing the timeline and specific reasons for being unable to obtain their
parental information. Be sure to
address both parents
in the statement and be as detailed and specific as possible.
2. A
signed and dated statement from a third party person, on letterhead, who has knowledge and information of the
unusual circumstances. A third party person can be a Counselor (High School, Social Worker, or Therapist), Clergy
(Priest, Minister, or Rabbi), Medical Personnel, Court or Prison Administrators, or anyone from the community that
can support your statement.
I hereby swear or affirm that all the information reported on this form is true, complete, and accurate to the best of my knowledge. I
understand that any false statements or misrepresentation will be cause for denial, reduction, withdrawal, and/or repayment of
financial aid. Additional information and documentation may be required and requested.
Student
Si
gnature
___ Date_____________________
1570 East Colorado Blvd. L-114, Pasadena, California 91106
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2003
19DPOV
