Financial Aid Office ● 197 Franklin St. • Auburn, NY  13021

   315-255-1743 ext. 2470 • Fax 315-252-2185

2014-2015 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 2014-2015 Free Application for Federal Student Aid (FAFSA):

An independent student is an individual who meets one of the following criteria:

1.      An individual born before January 1, 1991.

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, 2013 that he or she was a homeless unaccompanied youth.

11.  An individual who was determined a homeless unaccompanied youth on or after July 1, 2013 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, 2013 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. 


                     (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 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 professional who is not a family member, which verifies 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 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 2013 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. 3/14