Financial Aid Office
214 Center Grove Road, Randolph, NJ 07869
5230 (v) 973
5237 (f) Email:
Name _____________________________________________________ CCM ID# ______________________________
Address ___________________________________________________ Telephone ______________________________
Award year or period, you are petitioning for: ______________________________________________________________
Financial aid regulations assume that the family has primary responsibility for meeting the educational costs of students. If
you are considered a dependent student according to the financial aid definition, your aid eligibility is determined by using
parent income and asset information in addition to your information. Dependent students are required by law to provide
parental information and signatures to be considered for financial aid.
Occasionally, due to unusual circumstances students may not be considered a dependent. If you can document why you
should be considered independent for some unusual reason or circumstances, you may petition for a waiver of federal
regulations requiring parental information. In your petition, you should answer each of the following items:
l. Identify the location of both you parents.
2. Describe the last time you had contact with each of your parents-when, where, and the nature of the contact.
3. Explain what unusual circumstances (written) should make you an independent student with supporting documentation.
Describe how you have been self-supporting: a) when did you start meeting your expenses without parental support,
and b) how have you been providing for yourself?
4. The list below, is a few of the documents which we require:
a. Statement of support (including, expense and earnings/means of support)
b. Copies of your federal income tax return transcript for the last two (2) years, if filed.
c. Copies of your most recent Lease and Utility bills (Gas/Electric-statement) for the last two years. Note: Phone,
Cable and Food bills are not acceptable.
d. Provide statements from three responsible adults who are aware of your situation- At least two statements must be
from someone who is not a relative or a friend.
e. At least one of the following 3
party; supporting your petition for Independency:
Copies of relevant court documents, Legal Aide/Lawyer, Guidance Counselor, Police report or Minister/Clergy
*** All statements must be notarized ***
5. Certify below: I have attached statements from the following persons (give name, address, job title, and relationship to
1. _______________________________________________________________________________________________
2. _______________________________________________________________________________________________
I certify that the information provided in this petition is true and correct:
Student Signature: _______________________________________________ Date: ________________________
For Office Use only:
______ Accepted per professional judgement based on unusual circumstances denied
______ Denied Reason for denial: _______________________________________________________________
Initials ___________ Date ______________