Yuba Community College District
Financial Aid Offices
Yuba College
2088 North Beale Road
Marysville, CA 95901
530-749-7999
Woodland Community College
2300 East Gibson Road
Woodland, CA 95776
530-661-5725
Lake County Campus
15880 Dam Road Extension
Clearlake, CA 95422
707-995-7923
2020-2021 Request for Dependency Override
This form is for dependent students who do not meet the federal criteria for “independent” status as outlined
on the 2020-2021 Free Application for Federal Student Aid (FAFSA) but who would like to have their unique
circumstances reviewed in order to be considered an independent student for financial aid purposes.
Students who are estranged from their parents due to extenuating or unusual circumstances (i.e. abuse, family
alcoholism, drug abuse) which can be documented by an objective third party (i.e. high school or college
counselor, social services agency official, pastor or clergy member, mental health professional, law
enforcement officer, teacher) may apply for a review of their dependency status.
ATTENTION: The following circumstances are not considered viable reasons for independent status:
You do not reside with your parents.
Your parents refuse to pay for your college education.
Your parents do not claim you on their tax return.
Your parents are not financially able to pay for your college education.
Your parents are not willing to complete the parent section of the FAFSA.
You do not rely on your parents for support, financially or otherwise.
INSTRUCTIONS
1. File the 2020-2021 FAFSA on the Web.
2. Submit all required forms and documents to the Financial Aid Office at the campus you attend.
3. DO NOT leave any questions unanswered. Incomplete requests will NOT be reviewed.
4. Complete ALL forms in ink.
5. Attach ALL required documentation (refer to list below).
DOCUMENTATION REQUIRED
1. Personal Statement: Attach a typed statement (letter) that explains your "unusual circumstance".
Don’t forget to include your name, student ID and signature on your letter.
Include the following information:
The whereabouts of your biological father and biological mother.
The last contact you had with each of your parents.
The nature of your relationship with your parents.
Why you cannot obtain information and/or support from your parents.
Your living arrangements during the last 2 years.
How you have supported yourself during the last 2 years.
2. Request for Review of Dependency Status form: Complete both sides of this form.
3. Affidavits In Lieu of Parent Information forms: Submit two completed and signed affidavits.
The affidavits should be completed by responsible adults (i.e. high school or college counselor,
social services agency official, pastor or clergy member, mental health professional, law
enforcement officer, teacher) who are able to verify the circumstances you described in your
personal statement. Affidavits from other students and/or friends are not considered an
independent third party.
4. Supporting Documentation:
Documentation confirming that a parent is deceased, institutionalized, or incarcerated.
Documentation confirming that there is protection/restraining order that prohibits you from
having contact with your parents.
Other legal documentation that would explain why parent information could not be obtained to
determine your financial aid eligibility.
5. 2018 Income Verification:
2018 Federal Income Tax Return: Include all W-2 forms, 1099 forms, attachments and schedules.
2018 Untaxed income verification (i.e. unemployment insurance, disability insurance, worker’s
comp).
V1 Independent Verification Worksheet: The V1 Independent Verification Worksheet is available
on MyCampus Portal.
6. 2019 and Current Income Verification:
2019 Federal Income Tax Return: Include all W-2 forms, 1099 forms, attachments and schedules.
2019 Untaxed income verification (i.e. unemployment insurance, disability insurance, worker’s
comp).
Current income verification: Provide your last or most recent check stub(s) from your current
employer(s).
Current untaxed income verification (i.e. unemployment insurance, disability insurance, worker’s
comp).
7. Other: ____________________________________________________________________________
8. Submit all required forms and documents to the Financial Aid Office at the campus you attend. DO
NOT leave any questions unanswered. Incomplete requests will NOT be reviewed.
REVIEW PROCEDURES
All submitted documentation will be reviewed by the Dean/Director of Financial Aid to determine
if the information you have provided supports your request.
You will be notified of the decision in writing at such time a decision has been made.
It generally takes three to four weeks to review and process your request. During peak periods
the process may take longer.
Yuba Community College District
Financial Aid Offices
Yuba College
2088 North Beale Road
Marysville, CA 95901
530-749-7999
Woodland Community College
2300 East Gibson Road
Woodland, CA 95776
530-661-5725
Lake County Campus
15880 Dam Road Extension
Clearlake, CA 95422
707-995-7923
2020-2021 Request for Dependency Override Application
Please complete this form to request a review of your dependency status. Complete this form in ink and do not leave any
questions blank.
STUDENT INFORMATION:
_______________________________________________________ _______________________________
First MI Last Social Security #
_______________________________________________________ _______________________________
Mailing Address Date of Birth
_______________________________________________________ _______________________________
City State Zip Code Phone Number
PLEASE ANSWER THE FOLLOWING QUESTIONS:
1. When is the last time you:
a) lived with your Father ______________________ Mother ______________________
b) received support from your Father ______________________ Mother ______________________
c) had any contact with your Father ______________________ Mother ______________________
2. Where are your parents currently?
Father ____________________________________ Mother ____________________________________
3. Did or will your parent(s) claim you as a dependent on their 2019 federal income tax return?
Yes No If yes, identify person and year: ________________________________________________
MEANS OF SUPPORT:
1. Did you work in 2019? Yes No If yes, provide proof of income earned.
2. Did you have any additional sources of income other than your job in 2019? Yes No
If yes, list source (i.e. cash support from others, Financial Aid, Social Security), yearly amount and year.
Source: _______________________________________ Total Income: __________________ Year: ___________
Source: _______________________________________ Total Income: __________________ Year: ___________
Source: _______________________________________ Total Income: __________________ Year: ___________
3. If you had no income in 2019, please explain how you supported yourself: _____________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Page 1 Dep Override Request
CURRENT INCOME AND EXPENSES:
1. How are you currently supporting yourself? Please explain: ________________________________________________
________________________________________________________________________________________________
2. W
hat is your current living arrangement? On Your Own With Parent(s
)
With friends or relatives (state who) _______________________________________________________________
3. Provide your current monthly expenses below. Only list expenses you are responsible for.
Rent/Mortgage _______________ Utilities (Electric, Gas, etc.) _______________
Food/Groceries _______________ Car Payment _______________
Phone/Cell Phone _______________ Auto Insurance _______________
Transportation _______________ Other: ____________________ _______________
I certify that the information provided on this form is true and correct to the best of my knowledge. I understand that
this information will be used to determine my eligibility for a dependency override and that false or misleading
information may be cause for denial, termination, and/or repayment of financial aid funds.
________________________________________________________ _______________________________
Student Signature Date
FOR OFFICE USE ONLY
FA Technician Recommendation: Approve Request Deny Request
__
________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
____
_________________________________________________ _________________________________
Financial Aid Technician
Date
FA Administrator Decision: Request Approved Request Denied Pending
_________________________________________________________________________________________________
_________________________________________________________________________________________________
____
_________________________________________________ _________________________________
Financial Aid Dean or Director
Date
P
age 2 Dep Override Request
Rev. 03/27/20
Yuba Community College District - Financial Aid
AFFIDAVIT IN LIEU OF PARENT'S INFORMATION
click to sign
signature
click to edit
_________________________________________________ ____________________________
Student's Name Student ID #
This form is to be completed by a third party who is familiar with your situation and has known you for a
minimum of two years, such as, a high school or college counselor, social services agency official, pastor or
clergy member, mental health professional, law enforcement officer, or teacher. Affidavits from other
students and/or friends are not considered an independent third party.
The student named above has indicated on the application for financial aid that he/she is unable to provide parent
information due to unusual circumstances. Please answer the following questions:
1. How long have you known the student? ______________________________________________________
2. In what capacity? ________________________________________________________________________
3. Please provide a brief statement regarding your knowledge of the student's family history and their
relationship with their parent(s). ____________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
4. Why is the student unable to provide parent information for financial aid purposes?
_______________________________________________________________________________________
_______________________________________________________________________________________
5. What is the last date the student:
a. Received financial support from parents? _____________________________________
b. Lived with parents? _____________________________________
6. How is the student currently supporting himself/herself? _____________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Name: ______________________________________________ Phone #: ___________________________
Relationship to Student: ________________________________ Occupation: ________________________
Mailing Address: ___________________________________________________________________________
I hereby certify that the above information contained in this affidavit is true and correct to the best of my knowledge.
___________________________________________________ ____________________________
Signature Date
Yuba Community College District - Financial Aid
AFFIDAVIT IN LIEU OF PARENT'S INFORMATION
_________________________________________________ ____________________________
click to sign
signature
click to edit
Student's Name Student ID #
This form is to be completed by a third party who is familiar with your situation and has known you for a
minimum of two years, such as, a high school or college counselor, social services agency official, pastor or
clergy member, mental health professional, law enforcement officer, or teacher. Affidavits from other
students and/or friends are not considered an independent third party.
The student named above has indicated on the application for financial aid that he/she is unable to provide parent
information due to unusual circumstances. Please answer the following questions:
1. How long have you known the student? ______________________________________________________
2. In what capacity? ________________________________________________________________________
3. Please provide a brief statement regarding your knowledge of the student's family history and their
relationship with their parent(s). ____________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
4. Why is the student unable to provide parent information for financial aid purposes?
_______________________________________________________________________________________
_______________________________________________________________________________________
5. What is the last date the student:
a. Received financial support from parents? _____________________________________
b. Lived with parents? _____________________________________
6. How is the student currently supporting himself/herself? _____________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Name: ______________________________________________ Phone #: ___________________________
Relationship to Student: ________________________________ Occupation: ________________________
Mailing Address: ___________________________________________________________________________
I hereby certify that the above information contained in this affidavit is true and correct to the best of my knowledge.
___________________________________________________ ____________________________
Signature Date
click to sign
signature
click to edit
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome