!
Quincy College Financial Aid Office | 1250 Hancock St., Quincy Center, MA 02169 | (p) 617-984-1620 | (f ) 984-1769 | quincycollege.edu
!
!
Petition To Apply For Financial Aid as an Independent Applicant
!
!
Name: Social Security Number: - -
!
!
Address: Academic Year
!
!
City: State:
Zip Code Phone Number
!
Financial Aid regulations assume that the family has primary responsibility for meeting the educational
cost 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 financial
information.
!
Occasionally, due to unusual circumstances a student should not be considered a dependent student. This
decision is made after careful consideration of the facts provided to the school along with this application.
Some of the circumstances that CANNOT be considered are: a student who no longer lives at home by
choice, a parent or stepparent(s) unwillingness to provide the necessary financial information to complete
the financial aid application or when a parent(s) lives in another state or country. You will be asked to
provide documentation that explains your request to be considered an independent student. You will be
required to provide supporting documentation in the form of letters or statements from people who are
intimately aware of your particular circumstance. Please be aware that if your application is not complete
we cannot review your request. Statements must be from relatives, clergy, counselors or older siblings.
!
1.
Identify the location of both your parents:
!
!
Mother/Stepmother:
Father/Stepfather:
!
!
2.
Describe the last time you had contact with each of your parents. When, where and the nature of the
contact (attach an extra page(s) if necessary):
Mother/Stepmother:
Father/Stepfather:
3.
Explain the unusual circumstances that you request we review with your application (attach extra
p
ages
if necessary).
!
!
!
!
!
4.
Provide statements from two adults who have intimate knowledge of your situation. One statement
may be a friend or family member. One statement must be from a clergy member, social worker; court
officer or professional with direct knowledge of your circumstances. Copies of appropriate court
documents are required if applicable to you.
!
5.
Please complete the following information to provide confirmation of your ability to support yourself:
!
Monthly Expenses: Monthly Income:
!
Rent/mortgage $
!
Telephone $
!
Utilities $
!
Cable $
!
Groceries $
Transportation $
Misc.Personal $
!
Employment $
Unemployment $
SSI/Disability $
Workers Comp $
TAFDC/EAEDC $
Friend/Relative $
!
InheritancelTrust $
!
!
TOTAL $
TOTAL $
!
!
Please provide copies of paid utility bills, lease and cancelled checks for other paid expenses. The
lease and utility bills should be in your name. If you share these expenses then provide proof that
you have paid your share.
!
!
!
6.
A signed copy of your Federal Tax Return for the previous two years and proof of any other sources of
income.
!
I CERTIFY THAT THE INFORMATION PROVIDED HERE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE.
!
!
Student Signature
!
!
!
Accept Denied
Date - -
!
!
!
Financial Aid Representative
!
!
Director of Financial Aid
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome