This application is to request a review of your
FAFSA dependency determination.
Federal Financial Aid Regulations place the
responsibility for meeting educational needs upon
the parent; however, in unusual cases, a student
may be able to provide sufficient documentation to
be considered “Independent.
A written appeal, including supporting
documentation, may be submitted to the Financial
Aid Office anytime. In addition to your appeal, you
must submit this form, and required Financial
Information via either the IRS Data Retrieval Tool,
or your IRS Tax Return Transcripts.
Please put your student ID number on all forms
submitted to the Financial Aid Office.
Student ID Number
Print Last Name First MI
Print Street Address
Print City State Zip
Telephone Number
The following reasons, individually or in combination, are not grounds for consideration:
1) Parent refuses to contribute to the student’s education
2) Parent is unwilling to provide documentation for the FAFSA or verification process
3) Parent does not claim student on tax return
4) Student demonstrates total self-support
In your written appeal, you must address the following:
1) Describe the last time you had contact with each of your parentswhen, where, under what
conditions
2) Provide the current location of both your parents
3) Explain what unusual circumstance you believe makes you independent for FAFSA purposes
4) Describe how you are currently supported (a) how do you provide support for yourself (b) are others
responsible for your support, if so, who (c) when did this current arrangement of support begin
In addition to your written appeal, you must provide the following:
5) Letters of support from two responsible adults who are aware of your situation. At least one letter
must be on letterhead from a guidance counselor, physician, teacher, social worker, case worker,
clergy person or other person directly involved with you in a professional capacity. All letters must
be signed, dated and include contact information (phone, email, etc) for follow up consultation.
6) Legal documents, lease agreements and/or utilities in your name, court records, police reports,
death certificate or other official correspondence that supports your request may be substituted for
one of the requirements mentioned in 5) above.
Request for
Independent Status Consideration
Family Member Name (Including
yourself)
Relationship
Age
College (if attending at least half-
time)
SELF
Submit this signed document, your written appeal and all required documentation to the Financial Aid Office.
The decision of the Financial Aid Office is final and cannot be appealed to the U.S. Department of
Education.
I swear under penalty of perjury that all of the information contained in this application is true to the best of my
knowledge. I understand that providing false or misleading information in an attempt to obtain federal financial
aid can result in a fine of up to $10,000 and/or incarceration. I understand that failure to provide the
required documentation will result in denial of this application.
Student’s Signature: _________________________________ Date: _____________________________
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