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2020-21! Appeal! for! Dependency! Override!
Student Name: UH! ID #:
Phone Number: Da
te of Birth:
Federal regulations (
Public Law 102-325, Sec. 480! (d)) require that the Financial Aid Office consider parent information and expect
parent con tribution for stu dents! unless! the student m eets! one of the following co nditions:
1.
is 24 years or older by December 31 of the award year (born before January 1, 1997); or
2.
is a graduate or professional!student;!or
3.
is married;!or
4.
have children! who! receive more than half of their support from you; or
5.
have legal dependents (other than children or spouse) who receive more than half of their support from you now and
through next! year; or
6.
is an orphan or ward of the court; or
7.
is currently serving on active duty in the U.S.! Armed! Forces for purposes other than training;or
8.
is a veteran of the U.S Armed Forces;!or
9.
is an emancipated minor;or
10.
is in legal!guardianship;or
11.
is an unaccompanied youth who was homeless as determined by:
a.
your high school or school district homeless liaison,
b.
the director of an emergency shelter or transitional housing program funded by the U.S. Department of Housing
and Urban Development, or
c.
the!director! of! a!runaway!or! homeless youth basic center! or! transitional livingprogram.
The parent’s unwillingness (versus inability) or refusal to assist the student cannot be grounds for a! d ependency override. The
Financial Aid Office! may be! able! to override! your dependent status only if unusual circumstances exist that makes it impossible
for! you to have re as on ab le contact! w ith your! pa ren ts. If! your! family situation involves an unusual circumsta nc e, you may request
a! review of your dependency status by submitting:
1.
A! personal statement describing the relationship between you and your parents and the specific reasons you are unable
to secure!their! cooperation in completing!the!parent! information section of! the!Free!Application for! Federal Student Aid!
(FAFSA).
2.
At !least !one statement !on! official letterhead paper from an external (third party)! source who can document, verify and
support your situation (e.g. social workers, counselors, clergy members, or teachers).
I"certify "t
hat "th e "infor m a tio n "prov id e d is"t rue "a n d "corre ct "to "the "be s t "of "my "knowledge;" I" understand"t hat" any"f alse"s tatement"
or" misrepresentation"m ay" be" cause" for" denial," reduction"or " repayment" of" any" financial" aid" received."
Student Signature: Date:
RETURN THIS FORM ALONG WITH ANY OTHER' REQUIRED DOCUMENTATION TO THE COMMUNITY COLLEGE CAMPUS THAT YOU WILL BE ATTENDING:
Hawaiʻi Community College
1175! Manono Street *! Hilo, HI 96720
Honolulu! Community College
874! Dillingham Boulevard *! Honolulu, HI 96817
Kapiʻolani Community! College
4303! Diamond Head Road *! Honolulu, HI 96816
3-1901! Kaumualiʻi Highway *! Lihuʻe, HI 96766
Leeward Community College
96-045! Ala! ʻIke! Street *! Pearl City, H I 96782
University of Hawaiʻi Maui College
310! West Kaʻahumanu Ave! *! Kahului, HI 96732
Windward Community College
45-720! Keaʻahala! Road *! Kāneʻohe, HI 96744
The University is committed! to! a! policy of nondiscrimination! on! the basis of race, sex, gender identity and! expression, age, religion, !color, !national!origin, !ance stry , !citiz en sh ip , !d isa bility ,
genetic! information, marital status, breastfeeding, income! assignment for child support, arrest and court record (except as! permissible! under State! law), sexual orientation, national guard!
absence, or status! as! a! covered veteran.
UH Title! IX! Coordinators' names! and contact information are! available! at: https://www.hawaii.edu/titleix/help/coordinator/ and UH 504!
Coordinators’! n a mes and c
ontact information are available at:! https://www.hawaii.edu/offices/eeo/ada-504-coordinators/
UH' HILO, UH' WEST OAHU' AND' UH' MĀNOA' STUDENTS NEED' TO CONTACT THEIR FINANCIAL AID OFFICE' FOR CAMPUS' SPECIFIC FORMS.
Rev. !10/2019
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