Lorain County Community College Financial Services 1005 N. Abbe Rd, Elyria, OH 44035 Fax: 440-366-4634 Page 1 of 2
Independent Student Documentation Form
2020-21 Financial Aid Year
Section 1. Student Information
Last Name First Name Middle Initial
LCCC Student ID #
Section 2. Additional Documentation Requirements
Support for Dependents
You answered YES to one of the following questions on the 2020-21 FAFSA making you an independent student. Before we can
continue to process your request for financial aid, please provide the information:
If you answered “YES” to the question: “Do you have dependents (other than your children or spouse) who live with you
and who receive more than half of their support from you, now and through June 30, 2020?” then please complete the
additional household information below for the person(s) you are claiming as your dependent on the 2020-2021 FAFSA:
Does dependent(s) receive financial support from another agency (i.e., Social Security, Child Support, ODJFS, etc.)? If yes, please list
the name of the agency and amount of monthly support received, number of months received, and year received.
List Your Dependents
Dependent
Last Name
Dependent
First Name
Dependent’s
relationship
to you
Yes, receives
support from
another agency
No, does not
receive support
from another
agency
Agency
providing
support
Amt. of
Monthly
Support
No. of
Months
Year
Number of months you have or will provide support to the above dependent(s) from 7/1/20 through 6/30/21: _______________
Will any other custodial parent or individual (the child(ren)’s aunt, uncle, or grandparent(s)) other than yourself be claiming the
above dependent(s) on their 2019-2020 FAFSA? Yes No
If yes, please provide the name of the individual. _______________________________________
If requested, are you able to provide any legal documentation that will show legal relationship towards the above dependent(s)?
Yes No
Other Additional Documentation
If you answered “Yes” to the question: “At any time since you turned age 13, were both your parents deceased, were you in foster
care or were you a dependent or ward of the court?”
Please provide either death certificates or documentation confirming foster care of ward of the court status
If you answered “Yes” to the question: “As determined by the court in your state of legal residence, are you or were you an
emancipated minor?”
Lorain County Community College Financial Services 1005 N. Abbe Rd, Elyria, OH 44035 Fax: 440-366-4634 Page 2 of 2
Please provide supporting documentation from the court.
If you answered Yes” to the question: “As determined by a court in your state of legal residence, are you or were you in legal
guardianship?”
Please provide supporting documentation from the court
If you answered “Yes” to the question: “On or after July 1, 2019, were you homeless or were you at risk of being homeless”?
Please provide supporting documentation from the homeless shelter
Section 2. Certification.
I certify that all of the information reported is complete and accurate. Warning: If you purposely give false or misleading information on
this worksheet, you may be fined, sentenced to jail, or both.
Student Signature: Date
Electronic signatures will not be accepted. Please print this form to sign before submitting.
Section 3. Submission
You may submit your information by: a) mail to the address below; b) fax to 440-366-4634 or; c) deliver to Financial Services, First Floor, Bass Library. Do not email
any documents with personally identifiable information.
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