Fill - Free fillable Yuba Community College District Financial Aid Offices 2020-2021 (Woodland Community College) PDF form

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: ___________

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

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signature

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_________________________________________________ ____________________________

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

_________________________________________________ ____________________________

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signature

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