Fresno City College
Financial Aid Office
1101 E University Ave
Fresno, CA 93741
Phone: (559) 442-8245
Fax: (559) 499-6024
2022-2023
DEPENDENCY OVERRIDE FORM
INSTRUCTIONS:
1)
If you have not submitted a FAFSA for this year, apply at www.fafsa.gov
2)
Attach a typed written explanation regarding your relationship with your parents, why you no longer
live with your parents, why you no longer have contact, and why they do not financially support you.
3)
Attach your Third Party Documentation letter (instructions at end of form).
4)
Attach any legal documents or any other paperwork regarding your situation.
5)
After you have completed steps 1 through 4 call the Financial Aid office at (559) 442-8245 to make an
appointment for a Dependency Override.
STUDENT’S
DEMOGRAPHICS
NAME: STUDENT ID:
ADDRESS:
PHONE: E-MAIL:
STUDENT’S
PRESENT LIVING
ARRANGEMENTS
With whom do you currently live?
How long have you lived with this person/family? years months
How much do you pay in rent and utilities per month? $
Can you provide parental information for the FAFSA?
FATHER’S
INFORMATION
Father’s name:
Address:
When did you last live with your Father?
(month/year)
When was the last time you had contact with your Father?
(month/year)
When did your Father last provide financial support for you?
(month/year)
How often do you have contact with your Father?
MOTHER’S
INFORMATION
Mother’s name:
Address:
When did you last live with your Mother?
(month/year)
When was the last time you had contact with your Mother?
(month/year)
When did your Mother last provide financial support for you?
(month/year)
How often do you have contact with your Mother?
STUDENT
CERTIFICATION
I certify that the information provided is true and correct. I understand that any
false statements of misrepresentations will be cause for denial, reduction,
cancellation, or repayment of financial aid.
STUDENT
SIGNATURE
DATE
FF22CDOV Page 1 of 2 02/15/2022
Instructions for Third Party Documentation
In extraordinary and documented cases, the Financial Aid Office has authority to use
professional judgment to override a student’s dependency status to make a student
independent for financial aid purposes.
However, a student is not considered independent based solely on the following:
•
student is self sufficient
•
parents refuse to provide information or assist with educational expenses
•
parents did not claim student on tax return
The information stated in the Dependency Override Request must be verified by a third party
who is aware of the student’s home situation and can verify the information provided on the
Dependency Override Request. Examples of such a person include, but are not
limited to:
employer, clergy, social worker, attorney, court official, teacher, counselor, psychiatrist,
psychologist, medical professional, law enforcement agent, etc.
Instructions for third party documentation:
Third party documentation must be on official letterhead. Please include any information for
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
•
How long have you been aware of the student’s situation
•
When the student last lived with and/or received financial support from his/her parents
•
Any knowledge of his/her relationship with their parents
•
The steps that the student has taken to establish their independence from his/her
parents
Pl
ease make sure to include your professional title, name and type of business, business
address, telephone number and your contact information.
DEP
ENDENCY OVERRIDE REQUEST FORMS WILL NOT BE ACCEPTED WITHOUT THE THIRD-PARTY
DOCUMENTATION LETTER
F O R O F F I C E U S E O N L Y
Decision based on the following unusual circumstances:
Using PJ, this student is independent
Denied
Postponed/Date
FAO:
DATE:
FF22CDOV Page 2 of 2 02/15/2022
