Student Name __________________________________________________________ Request for Review of
Student ID or Star ID _____________________________________________________
Dependency Status
Phone ________-__________-________________ 2020-21
Email Address__________________________________________________________
Address_______________________________________________________________
City State Zip Code
Student Birthdate (MM/DD/YYYY) __________________________________________
The Financial Aid Office has been made aware that your status as a dependent student may not be accurate. In order to
best determine what your situation is, and what further information we may need, please review and complete the
information requested below, and submit this form to the Financial Aid Office. Do not leave any fields blank. Attach a
separate page if you need more space to explain your situation. The Financial Aid Office will review the information and
follow up with you regarding what additional steps you need to take and what further documentation we will need.
Why are you unable to provide parental information? Explain in detail your relationship with both of your
biological parents.
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When was the last time you lived with your parents (if you do not currently)?
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When was the last time you spoke to your parents? Do you have regular contact with them?
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Please continue on the back page
Financial Aid Office
3300 Century Avenue North
White Bear Lake, MN 55110
Phone: 651-779-3305
Fax: 651-779-5816
E-mail: finaid@century.edu
A MEMBER OF THE MINNESOTA STATE COLLEGES & UNIVERSITY SYSTEM
AN AFFIRMATIVE ACTION EQUAL OPPORTUNITY EMPLOYER & EDUCATOR
List type(s) of financial support you receive: Financial support from a family member or friend? County or state
benefits?
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Discuss your current living arrangement and housing situation. Do you live by yourself? Do you pay rent?
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Explain how you are able to support yourself. Are you employed? Who provides your health insurance,
transportation, etc?
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Please submit a copy of your health insurance card and all W2’s from the previous tax year along with this
form. Any form submitted without these documents will be automatically denied.
To assist in the decision making process, you may also wish to submit a letter of support from a community
member who knows of your situation and can attest to your status as an independent student.
By signing, I attest that all information provided is complete, accurate and true.
Student Signature ___________________________________________________________ Date ____________________
Financial Aid Office Use Only
Approved _______
Denied _________
Comments:
_____________________________________________________________________________________________________
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Financial Aid Staff Signature Date
click to sign
signature
click to edit
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