· CAYUGA COMMUNITY
COLLEGE ·
Financial Aid Office · Auburn 315-255-1743 ext. 2470 · Fulton 315-592-4143 ext. 3004 · FAX 315-252-2185
2013-2014 Appeal for Financial Aid
as an Independent Student
(Please read this
form carefully. Filing this form does
not guarantee that your appeal will be approved.)
______________________________________________________________________________________________________________
Last Name First
Name M.
I.
____________________________________________________________________________________________________
Street City State Zip
_______________________________________ C#_____________________________________________________
Phone Cayuga
ID#
Please complete the following form. Once you have entered the necessary
information online, you will need to print the form, provide all required
signatures and return it to the CCC Financial Aid Office. Additional information may be requested. You are considered an INDEPENDENT STUDENT for
Financial Aid purposes if you meet one of the following conditions at the time
you complete and sign the 2013-2014 Free Application for Federal Student Aid
(FAFSA):
2013-2014 FEDERAL
DEPENDENCY STATUS
An independent student is an individual who meets one of
the following criteria:
1. An individual born before January 1, 1990.
2. An individual who is married at the time of application for
federal student aid.
3. A graduate or professional student.
4. An individual who is currently serving on active duty in the Armed
Forces for purposes other than training.
5. A veteran of the Armed Forces of the United States.
6. An individual with legal dependents other than a spouse. This
includes children born during the award year.
7. An individual at the age of 13 or older, whose parents were both
deceased, who was in foster care, or was an orphan or ward of the court.
8. An emancipated minor as determined by a court in his or her state
of legal residence. Please note – New
York State does NOT recognize
emancipation as a form of independence for financial aid purposes.
9. An individual in legal guardianship as determined by a court in
his or her state of legal residence.
10. An individual whose high school or school district liaison
determined on or after July 1, 2012 that he or she was a homeless unaccompanied
youth.
11. An individual who was determined a homeless unaccompanied youth on
or after July 1, 2012 by the director of an emergency shelter program.
12. An individual who was determined a homeless unaccompanied youth,
or self-supporting youth at risk of being homeless, on or after July 1, 2012 by
the director of a runaway or homeless youth basic center or transitional living
program.
*Note: If you meet one of the above conditions, you
do not need to complete this form.
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A. Reasons
for Appeal
Many students feel they are independent because they
currently live on their own, or because their parents refuse to provide
information on the FAFSA, or because their parents cannot afford to help with
college expenses. However, these reasons are not sufficient for an
appeal. The Financial Aid Office is
required to consider parent information and expect a parental contribution for
students who are not independent according to the above FAFSA definition,
unless exceptions are made. Exceptions are made only when adequate
documentation of extenuating family circumstances exist. Extenuating circumstances are generally
defined by a student’s inability to have contact with his or her parents.
Review the following reasons for appeal and check the one
that describes your circumstance.
If none of these circumstances apply to your situation, do
not complete this form.
1. Severe circumstances within your
family prevent you from obtaining your parents’ financial information.
Examples:
(a)
an abusive home situation which is detrimental to your physical or
mental well-being
(b)
abandonment by both parents
(c)
history of parental alcohol or drug abuse
(d)
incarceration of the custodial parent and inability to obtain other
parent’s information
(e)
other extenuating circumstances not described above
2. Death of a parent after filing
the FAFSA and the surviving parent meets one of the severe circumstances
listed above.
B. Personal
Statement and Documentation
Attach
a written personal statement (preferably typed) which completely and explicitly
explains the basis of your appeal.
Please note that your statement will be used only to determine if a
dependency exception should be made. This
information will be held in strictest confidence.
Make
sure your statement is signed and dated.
Attach at least one
acceptable source of documentation which verifies all the facts of your appeal.
Acceptable sources of documentation are listed below according to the
reason for your appeal.
1.
If you checked Reason #1, provide one or more of the following acceptable
sources:
Signed
statements from an adult professionals who is not family member, which verify
the family circumstances
described
in your personal statement. Adult
professionals include clergy members, attorneys, school guidance
counselors,
medical doctors, mental health professionals, teachers or professors, law
enforcement officers,
professional
staff of Children and Family Services (Public Assistance Department) and
officers of the court.
Letters must be signed originals
on agency letterhead with the professional’s title (Counselor, Rabbi, etc.).
2.
If you checked Reason #2, provide one of the above sources and a photocopy of your parent’s death
certificate or
newspaper obituary.
C. Additional
Information (Answer all four
questions)
1. In what year were
you last claimed by your parent(s) as a dependent on a Federal Tax Return?
(1040
or 1040A) Year
2. When did you last
live with your parent(s)?
Month/Year
3. When did you last
receive financial support from your parent(s)?
Month/Year
4. Did you file a 2012
Federal Tax Return? Yes or No
D. Student
Certification (Read carefully
before you sign)
I
hereby certify that all information contained in this appeal for independent
status, including my personal
statement
and other documentation, is true and complete to the best of my knowledge. I swear or affirm that I
have
not knowingly or intentionally provided any false statements or fraudulent
documentation. I understand
that
if I am found to have knowingly or intentionally given false or fraudulent
statements and/or documentation,
my appeal will be denied and my eligibility for Federal and State student aid
jeopardized.
___________________________________________________
_____________________________
Signature Date
Please return this form to the
Financial Aid Office at Cayuga Community College
197 Franklin St., Auburn, NY
13021-3099.
______________________________________________________________________________________________________________
Results of Appeal
_________________________________________________
FAA Signature
_________________________________________________ Date_______________________
bpr Rev. 1/13