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A student may request a dependency override if (Redlands Community College)

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A student may request a dependency override if they do not meet the statutory definition for independent status for federal
financial aid recipients. To be considered independent you must be able to document unusual or exceptional family
circumstances. Living in your own apartment, paying rent or other bills, claiming yourself on your federal tax return,
and/or parents not claiming you on their taxes do not constitute unusual circumstances.
This form is for dependent students who do not meet the federal criteria for “independent” status but wish to have their
unique circumstances reviewed in order to be considered an independent student. Students who are estranged from their
parents due to extreme circumstances (e.g., child abuse, abandonment, family alcoholism, drug abuse, etc.) which can be
documented by an objective third party (e.g., pastor, high school or college counselor, a social service agency official, etc.)
may qualify for this special treatment. A student may NOT appeal to be an independent due to:
Parent refuses to complete the FAFSA
Parent refuses to provide the required documentation
Student refuses to request information from the parents
Student is not claimed as an exemption on parent’s federal tax return
Student is not supported financially by the parent(s).
Incomplete requests will be returned to the student and not reviewed.
Name:
Date:
SSN/RCC ID:
Telephone:
Address:
City, State, Zip:
A. Student Information:
Indicate the amount and source(s) of your annual income for 2019, 2020 and 2021. Attach signed copies of your 2019 &
2020 federal tax returns, statements from social services, W-2 forms, etc. Include both taxable and non-taxable income.
2019 $__________ Source ________________________________________
2020 $__________ Source ________________________________________
2021 $__________ Source ________________________________________
Where did you live in: (Please circle the appropriate response)
2019: with parents with relatives on your own other _______________
2020: with parents with relatives on your own other _______________
2021: with parents with relatives on your own other _______________
Expenses: Complete calendar year expenses by using total amounts for each item.
2019 2020 2021
$_________ $_________ $________ Housing (rent or house payments)
$_________ $_________ $________ Food
$_________ $_________ $________ Transportation (car payments, gas, insurance)
$_________ $_________ $________ Utilities (gas, water, electric, cable)
$_________ $_________ $________ Personal (entertainment, cell phone, clothing)
$_________ $_________ $________ TOTAL
2021-2022
Petition for Dependency Status Review
Office of Financial Aid
1300 S Country Club Road - El Reno, OK 73036
405-422-6250 – Fax: 405-422-1463
B. Parent Information, if any:
List any expenses paid on your behalf by your parents in 2019, 2020 or 2021. (Example medical or car insurance)
2019 $_____________________ type______________________________
2020 $_____________________ type______________________________
2021 $_____________________ type______________________________
Did or will your parents claim you on their taxes as a dependent in 2018? _____Yes _____No
Did or will your parents claim you on their taxes as a dependent in 2019? _____Yes _____No
Will your parents claim you on their taxes as a dependent in 2020? _____Yes _____No
Incomplete requests will be returned to the student and not reviewed.
Attach a statement as to why you feel you are independent. Use a separate sheet of paper to explain why you feel
you should not be considered a dependent of your parents for financial aid purposes. The statement should explain
the situation in detail and include the following:
Identify the location of both of your parents.
Describe the last time you had contact with your parent(s) – when, where and the nature of the visit.
Describe the unusual circumstances that you feel make you an independent student.
Describe how you have been self supporting.
Attach supporting documentation. Your supporting documentation should include at least two (2) third party letters
from individuals who will not be biased on your behalf, but who have first-hand knowledge of your situation and
who can present the facts related to your particular situation. This may include, but is not limited to court documents,
letters from counselors, and members of the clergy or social workers.
Attach signed federal tax return, W2(s), and any other documentation of income (taxed and untaxed).
C. Certification
By signing this form, I certify that the above information is correct and complete to the best of my knowledge and belief. If
asked by an authorized official, I agree to give proof of the information provided on this form. I realize that giving false or
misleading information may result in a $10,000 fine, a prison sentence, or both (Higher Education Act, Sec. 490 (a)). I also
understand that I may submit only one appeal per academic year, and that the decision of the Director/Coordinator of
Financial Aid is final.
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A student may request a dependency override if (Redlands Community College)

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Completed 3 February 2021

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