Appeal for Independent Status

Financial Aid Office

112 College Drive

Wells, Maine 04090

207-646-9282 ext. 312

Dependency Override Request and Instructions for Third Party Documentation

In extraordinary and documented cases, the financial aid office has the authority to use professional judgement to override a student’s dependency status in order to make a student independent for the purpose of applying for financial aid. A student must be unable to obtain his/her parents’ information because of extenuating circumstances.

Parents’ unwillingness to provide the information, or inability to help support the student are not acceptable reasons for an appeal. Students should submit a Dependency Override Request and two third party reference letters to the financial aid office for consideration of a dependency override.

The information stated in the Dependency Override Request must be verified by a third party who is aware of your home situation and can verify the information you have provided. Examples of such persons include, but are not limited to: employer, clergy, social worker, attorney, court official, teacher, counselor, psychiatrist, psychologist, medical professional, law enforcement agent, immediate family, etc.

Instructions for third party references:

Third party references should submit separate signed and dates statements, preferably on letterheads. Please include any information of which you have firsthand knowledge and that you feel best describes the student’s situation. The following is a list of information that MUST be included in your letter:

How long have you known the student?
Your relationship to the student
When was the last time the student lived with and/or received financial support from his/her parents?
Any knowledge of his/her relationship with his/her parents, and parents’ wherabouts.
The steps that the student has taken to establish their independence from his/her parents

Please make sure to include your professional title, name and type of business, business address, telephone number, and where to contact you should any additional information be required. Please see examples of acceptable supporting documentation listed below:

*Death of Parent

- Copy of death certificate or obituary

- If student and parent have different last names, provide a copy of student’s birth certificate

*Parent is in Jail

- Statement from facility or courthouse indicating jail sentence and expected release date

*Parent(s) Wherabouts are unknown

- Third party reference must specify that parents’ whereabouts are not known

DEPENDENCY OVERRIDE REQUEST FORMS MAY NOT BE ACCEPTED WITHOUT THE THIRD PARTY DOCUMENTATION LETTERS ATTACHED!

Financial Aid Office

112 College Drive

Wells, Maine 04090

207-646-9282 ext. 312

Dependency Override Request

*Two Third Party References must be attached to this form

*MUST complete all items- DO NOT LEAVE ITEMS BLANK

Student Demographics:	Name:_______________________________________________________________ DOB:_____________________ SSN:__________________________ Address:_____________________________________________________________ City, State, Zip:_______________________________________________________ Phone Number:_______________________Cell Number:_____________________
Student’s Income Information	Current Year Total Income: $___________Prior Year Total Income: $____________ (Include ALL sources of income: wages, untaxed income, interest income, etc)
Student’s Present Living Arrangements:	Who do you live with? Name: ___________________________________________ Relationship: ________________________________________________________ Monthly rent and utilities: Number of years/months at current residence: $_____________________ ____________years _____________months
How do you support yourself and meet expenses? If your income is insufficient, explain how you support yourself (roommates, someone else supporting you, etc.).	____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________
Parent Information: (If deceased or unknown, indicate so.)	Father’s Name: _______________________________________________________ Address: ____________________________________________________________ City, State, Zip: ______________________________________________________ Mother’s Name: ______________________________________________________ Address: ____________________________________________________________ City, State, Zip: _______________________________________________________
Dependency History:	When did you last live with your parent(s)?_________________________________ When did your parent(s) last provide any monetary support for you?_____________ When was the last time you had contact with your parent(s)?___________________ How often do you have contact with your parent(s)?__________________________

Explain the circumstances and history behind your home situation, why you no longer live with your parents, and why they no longer support you. Circumstances for both parents must be mentioned. (If parent(s) is deceased, documentation must be attached). If the space provided is not sufficient to complete your answer please continue on an additional piece of paper and attach.

________________________________________________________________________________________________________________

Student Certification:

I certify that the information provided on this form is true and correct. I also understand that it will be used to override federal regulations regarding my dependency status.

I understand that I must complete this every year that I am considered a Dependent student by federal regulations if I wish to be considered for Independent status.

I understand that if my situation changes in any way, if I move back with my parents or receive any kind of support from them, that I must report this information to the Financial Aid Office.

I fully understand that to falsify any information on this form in order to receive Federal Title IV funds is a federal offense.

I understand that by signing this form, I authorize the Financial Aid Office to contact my third-party references and verify any information supplied on this form.

Student Signature:______________________________________________ Date: __________________

FOR OFFICE USE ONLY:

The Financial Aid Office has used Professional Judgement and determined that this student is:

INDEPENDENT DEPENDENT

Remarks:

_____________________________________________________________________________________

FAA Signature:__________________________________________ Date: _______________________