Fillable Request For Independent Status Form (Eastern Wyoming College)

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Request For Independent Status Form (Eastern Wyoming College)

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Financial Aid Office
3200 West C Street
Torrington, WY 82240
p: 307.532.8224
f: 307.532.8222
financialaid@ewc.wy.edu
2019-2020
Request for
Independent Status
(Dependency Override Appeal)
Section 480(d) of the Higher Education Act of 1965, as amended (HEA), defines an independent student as someone who fits
into one of the following categories. A student is considered independent if he or she:
• Was born before January 1, 1996;
• Is an orphan, in foster care or is a ward of the court at any time since age 13;
• Is an emancipated minor as determined by a court in his/her state of legal residence;
• Is in legal guardianship as determined by a court in his/her state of legal residence;
• *Is an unaccompanied youth who is homeless or at risk of being homeless as determined on or after July 1, 2018, by a
school district homeless liaison or the director of an emergency shelter or transitional housing program;
• Is a graduate or professional student;
• Is married;
• Has legal dependents other than a spouse for whom he/she provides more than half their financial support; OR
• Is a student for whom a financial aid administrator makes a documented determination of independence by reason of
other unusual circumstances. This documented determination is the Dependency Override.
Examples of unusual circumstances include:
• You were married and maintained a residence apart from your parents and your spouse’s parents. You are now
divorced, have no dependents, maintain a residence separate from your parents, and pay all the expenses from your
own income.
• Loss of a dependent
• *Severe circumstances within your family prevent you from obtaining your parents’ financial information:
o family abuse or neglect,
o parental abandonment, or
o other situations where contact between you and your parents is non-existent.
According to guidance from the U.S. Department of Education, the following circumstances do not qualify as unusual
circumstances and do not merit a dependency override:
• Parents refuse to contribute to the student’s education;
• Parents are unwilling to provide information on the Free Application for Federal Student Aid (FAFSA) or to complete
the verification process;
• Parents do not claim the student as a dependent for income tax purposes;
• Student demonstrates total self-sufficiency;
• Incarceration or confinement.
*If you are an unaccompanied youth who on or after July 1, 2018, was homeless, at risk of being homeless, or have an unusual
circumstance due to abuse or neglect, parental abandonment, or other situations where contact between you and your parent(s) is
non-existent, please complete our “Unaccompanied Homeless Youth and Unusual Circumstance Verification” form first. You
only need to submit a Request for Independent Status if you have already completed the “Unaccompanied Homeless Youth and
Unusual Circumstance Verification” form and were then asked by the Financial Aid Office to submit this appeal to determine
eligibility.
Please Note:
• You will be notified in writing of the appeal committee’s decision. This process may take up to 30 days.
• If your appeal is incomplete or submitted without the necessary documentation, processing of your appeal will be
delayed until the additional information is obtained. Appeals must be submitted by mid-term of the semester for
which you are requesting aid.
• Submission of an appeal does not guarantee your request will be approved.
• If approved, the Dependency Override is valid for only one academic year. Approval in one year does not guarantee
approval in following years. Your status must be reassessed each academic year.
• An approval by the EWC Financial Aid Appeal Committee is relevant only to your application at EWC. Each
institution to which you apply must make its own determination of your dependency status. No school is obligated to
accept a decision made by another school.
Over
In addition to completing this form and providing all situation-specific supporting documentation (listed in Section B: Reason
for Submitting Appeal), ALL APPEALS MUST INCLUDE the following documentation:
Signed copy of your 2017 Federal Income Tax Return and W-2 forms. If you were not employed, include an
explanation of how your living expenses were covered in your statement (Section D). You may also need to provide an
official IRS Tax Transcript or Verification of Nonfiling Letter.
Documentation of your current year income to date from all income sources.
A copy of your current lease agreement, mortgage statement or rent receipt. If you do not have a lease or mortgage in
your name, include an explanation of your current living situation in your statement (Section D).
Court or other official documentation of your status (e.g. guardianship, HHS documentation).
A signed statement from your guardian (if applicable) detailing your circumstances.
MUST INCLUDE: A signed statement from a third party who is knowledgeable of your family situation and can verify
the reason you are unable to provide your parents’ information. This third party should be someone unrelated to you.
The statement should be on letterhead and should list the person’s relationship to you and a contact number.
Appropriate third-party statements are from clergy, school counselors, teachers or similar professionals.
___________________________________________________________ ____________________ __________________________
Last Name First Name M.I. EWC Student ID Number Social Security Number (last four digits)
___________________________________________________________ _______________________________________________
Mailing Address (include apartment number) E-mail Address
___________________________________________________________ _______________________________________________
City, ST, Zip Phone Number (include area code)
A. You were married and maintained a residence apart from your parents and your spouse’s parents. You are now
divorced, have no dependents, maintain a residence separate from your parents, and pay all the expenses from your ow
n
i
ncome.
In addition to the above required documentation, you must submit:
o Proof of divorce.
o Copies of utility or other bills in your own name
.
B. Loss of a dependent.
In addition to the above required documentation, you must submit:
o Documentation of loss of dependent.
C. Severe circumstances within your family prevent you from obtaining your parents’ financial information.
P
lease note: If you are an unaccompanied youth who on or after July 1, 2018, was homeless, at risk of being
homeless, or have an unusual circumstance due to abuse or neglect, parental abandonment, or other situations where
contact between you and your parent(s) is non-existent, please complete our “Unaccompanied Homeless Youth and
Unusual Circumstance Verification” form first. You only need to submit a Request for Independent Status if you
have already completed the “Unaccompanied Homeless Youth and Unusual Circumstance Verification” form and
were then asked by the Financial Aid Office to submit this appeal to determine eligibility.
A: STUDENT INFORMATION
REQUIRED DOCUMENTATION
B: REASON FOR SUBMITTING APPEAL
How long have you lived at your current address? __________ Years Months
Is the lease or mortgage in your name?
Yes (attach a copy of your lease or mortgage)
No (attach a copy of your current lease agreement, mortgage statement or rent receipt. If you do not have a lease or
mortgage in your name, attach a statement explaining your current living situation)
Parent 1 name Parent 2 name
Address Address
City, State, Zip City, State, Zip
Do you live with your parent(s) during school breaks?
Yes No
When did you last live with your parent(s)?
When did your parent(s) last provide any monetary support for you?
When did you last have contact with your parent(s)?
How often do you have contact with your parent(s)?
Are you covered by your parent(s) medical insurance? Yes No
Are you covered by your parent(s) car insurance?
Yes No
Do you have your own medical and/or car insurance?
Yes No
If yes, attach a copy of your current policies
Do you own your own vehicle?
Yes No
If yes, attach a copy of your title, registration, and loan
Are all utilities (electricity, gas, phone) in your name? Yes No
Cash support from people other than your parents (includes amounts paid by others for bills in your name).
Purpose (e.g., cash, rent, books,
cell phone bill, car insurance, etc.)
Source of payment
Total amount
received in 2017
$
$
$
$
$
$
In-kind support is support other than money (e.g., friends giving you food or allowing you to live with them rent free).
Source of support
C: EXPLANATION OF SPECIAL CIRCUMSTANCES
Over
CURRENT EXPENSES – Estimate your current monthly expenses and how they are met.
EXPENSE
MONTHLY COST
WHO PAYS THE EXPENSE
Housing
$
Utilities
$
Food
$
Clothing
$
Transportation
$
Medical insurance
$
Cell Phone
$
Other
$
CURRENT INCOME
TYPE OF INCOME
MONTHLY AMOUNT
SOURCE
Wages
$
Untaxed income
$
Cash support (listed above)
$
Other
$
Please provide a signed statement (typed on a separate sheet of paper or neatly hand-written below) that explains in detail the extreme,
unique, and/or unusual family circumstances that prevent you from obtaining and providing your parents’ information for your
financial aid application.
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
By signing this worksheet, I certify that all of the information reported is complete and correct. I agree to provide additional information
or documentation deemed necessary by the Financial Aid Appeal Committee, including court documentation. I also acknowledge that I
have read and agree to comply with all verification policies as stated by EWC in the College Catalog and on the EWC website. Failure
to submit information in a timely fashion may result in the application being filed as inactive with no further consideration and no
federal aid for the academic year.
Student signature: _________________________________________________ Date: ___________________________
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, sentenced to jail, or both.
11/2018
E: CERTIFICATION AND SIGNATURE
EXPLANATION OF SPECIAL CIRCUMSTANCES (continued)
D. STATEMENT DETAILING CIRCUMSTANCES
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Request For Independent Status Form (Eastern Wyoming College)

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Completed 23 July 2020

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