CAYUGA
COMMUNITY COLLEGE
Financial
Aid Office - Auburn 315-255-1743 ext. 2470 - Fulton 315-592-4143 ext. 3004 -
FAX 315-252-2185
2012-2013
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 Banner ID Number
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 2012-2013 Free Application for
Federal Student Aid (FAFSA):
2012-2013 FEDERAL DEPENDENCY STATUS
An independent student is an individual who meets one of the following
criteria:
1. An individual born before January 1, 1989.
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, 2011 that he or she was a
homeless unaccompanied youth.
11. An individual who was determined a
homeless unaccompanied youth on or after July 1, 2011 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, 2011 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.
* *
* * *
* * *
* * *
* * *
* * *
* * *
* * *
* * *
* * *
* * *
* * *
* * *
* * *
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.
A.
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 2011 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. 2/12