FINANCIAL AID OFFICE
Independent Status Reaffirmation Form
Name:
Student ID: Date of Birth:
Address:
City: State: Zip:
Phone Number:
The Financial Aid Office has approved your independent status appeal for a previous award year.
Federal regulations require that we verify that the unusual circumstances between you and your
parents have not changed. If the situation between you and your parents has not changed, read the
statement below. If you accept the statement, sign this form and return it to the Financial Aid
Office.
Certification Statement for Independent Status
I certify that the unusual circumstances between my parents and I have not changed. The
information provided in my appeal is still true and correct. I agree to notify the Financial Aid
Office if the situation between my parent(s) and I changes. If I give false or misleading information
on this or any financial aid document, I may be fined, sentenced to jail or both.
_____________________________________________________ ______________________
Student Signature Date
