(2020-2021 Academic Year)
2800 S Lone Tree Rd Flagstaff, AZ 86005-2701 PH: 928-226-4219 FAX: 928-226-4110
FA-406-INDAPP 20200420
All Request for Independency Status Appeals must provide the following documentation:
2018 Tax Return Transcript
Copies of all 2018 W-2’s
Independent Verification Worksheet
Additional required documentation is listed on 2
page of appeal
The purpose of this appeal is to prove independency for those students who do not meet the independency criteria set
forth by the U.S. Department of Education in Step 3 of the 2020-2021 Free Application for Federal Student Aid (FAFSA).
The basic premise underlying student financial aid is that it is the responsibility of the student and his or her family to pay
educational costs. However, students who have extreme or extenuating circumstances may be considered to have their
status changed through an appeal process.
Note: Submission of the FAFSA is to determine what level of contribution should be expected from the family. For low-
income families, this contribution is often zero or minimal; a change in dependency may have little or no influence on the
student’s eligibility for financial aid.
The following are examples of extreme or extenuating circumstances which may be considered on appeal.
However these circumstances do not guarantee an approval to Independent status:
You are a refugee whose parent(s) are in another country*;
You have a documented case of abuse*;
You have been legally removed from your parent(s) home*.
*Documentation of the applicable circumstances must accompany the appeal.
Examples of circumstances (but not limited to) that ARE NOT considered extreme or extenuating. Typically,
these circumstances are not a basis for an appeal:
You don’t live with your parent(s);
You have not been in contact with your parent(s);
Your parent(s) have not claimed you on their Federal income taxes;
Your parent(s) refuse to complete their portion of the FAFSA;
Your parent(s) don’t want to help pay for your education
You have income sufficient to support yourself;
You received financial aid as an independent student in previous school years;
You are not a refugee, but your parent(s) live in another country;
You are divorced or widowed
You were a ward of the state (not to be confused with Ward of the Court)
CCC ID# Last Name First Name MI
Mailing Address City ST Zip Code
Telephone No. (include area code) Email Address
(2020-2021 Academic Year)
2800 S Lone Tree Rd Flagstaff, AZ 86005-2701 PH: 928-226-4219 FAX: 928-226-4110
FA-406-INDAPP 20200420
Required Documentation for Extreme or Extenuating Circumstances:
Under extreme or extenuating circumstances the Office of Student Financial Aid may review the dependent status for
students. If you have extreme or extenuating circumstances, you MUST complete the following required
documentation, failure to submit the documentation will result in a denial:
Personal letter of explanation regarding how you came to support yourself and the time period you have done
this. Describe the events in your family, which led to your current separation from them. If you are receiving
support from friends or relatives, describe the nature of that support (monies received; housing; food; clothing;
etc.) and who provides the support. Provide any and all information, which you feel will help to outline your
Signed and dated letter from a professional (clergy, counselor, teacher, etc.) that can document your extreme or
unusual circumstances. This letter should be on letterhead from the individual’s employment along with contact
information. A letter from a friend or family member is not acceptable.
Copies of all applicable court, police or legal documentation pertaining to your circumstance.
Renewal of Dependency Override (ONLY for students who have previously been approved at CCC):
If you received financial aid as an Independent student at CCC based on an appeal submitted previously, you are
required to resubmit an appeal each academic year. The circumstances under which you were granted independency
must be reaffirmed. Please check the appropriate box and provide required documentation.
The special circumstances under which I was granted Independency status in 2019-2020 have not changed.
Provide any documentation that updates and/or reaffirms your situation.
My circumstances have changed. Please attach documentation of changes along with a personal letter of
explanation. Attach any documentation which updates your status. You may be asked to provide additional
Allow 10 working days after an appeal is submitted before a decision is made. If a decision has not been made
on your appeal by drop for non-payment date, you must make payment or sign up for the College Payment Plan;
otherwise your classes will be dropped for non-payment.
I certify that the information provided on this form is complete and accurate to the best of my knowledge. I understand that submission of false
information may result in a delay or denial of federal financial aid and may subject me to criminal charges. I understand that purposely giving
false or misleading information may result in a fine of up to $20,000, being sent to prison, or both. I understand that if I do not give proof when
asked, this request will not be processed. I hereby provide consent for the use of electronic records and signatures on all financial aid
documents. I understand that if I choose to sign electronically, my electronic signature constitutes a binding contract and may not be denied
legal effect, validity, or enforceability solely because it is in electronic form or because an electronic signature or electronic record was used
in its formation.
Student’s Signature and Date How do I create a digital signature with Adobe?
For OSFA Use Only:
Prior year special conditions: Yes No If “Yes,” request documentation of 2018 income.
click to sign
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