*PINREA*
115 South Street Middletown, NY 10940 (845)341-4190 fax (845)341-4194
1 Washington Center Newburgh, NY 12550 (845) 562-245 fax (845)220-4062
www.sunyorange.edu
OFFICE OF FINANCIAL AID
2015-2016 AID YEAR
Dependency Override Affirmation Form
In the 2014-2015 academic year I was granted a dependency override from the Office of Financial Aid at
Orange County Community College. According to Federal regulations, “Not only do dependency overrides not
carry over from one school to another, they do not carry from one year to the next; if the student is not
independent for some other reason, the Financial Aid Office must reaffirm each year that the unusual
circumstances persist and that an override is still justified”.
I, _____________________ _____________________ reaffirm that the circumstances I used to support my petition for
(First Name) (Last Name)
Independence included in the documentation submitted, still exist.
CERTIFICATIONS AND SIGNATURES
Electronic Certification Agreement. By providing your “electronic” student signature, student ID # and by selecting the
“Accept" button, you consent that all of the information reported is complete and correct.
Student Accept:
Student Signature:______________________________________Date:___/ __/ _____
WARNING: If you purposely give false or misleading information on the worksheet, you may be fined,
be sentenced to jail, or both.
*1516*
