Dependency Appeal Form printable pdf download

Financial Aid Office

9801 Frankford Ave.

Philadelphia, PA 19114

Phone: 267-341-3233

Fax: 215-599-1694

finaid@holyfamily.edu

2016-2017 Dependency Appeal Form

PLEASE PRINT

STUDENT’S NAME: ______________________________________________________________________________________

HOLY FAMILY ID: ___________________

SOCIAL SECURITY NUMBER: _________________________

ADDRESS: _______________________________________________________________________________________________

STREET ADDRESS

CITY

STATE

ZIP

DAYTIME PHONE: _____________________________

EVENING PHONE: ____________________________

Step 3

Your response to

of the Free Application for Federal Student Aid (FAFSA) determines whether or not you are

Step 3

considered dependent or independent for financial aid purposes. If you do not meet any of the criteria in

of the

FAFSA, you are considered a dependent student and are required to provide parental information on the FAFSA.

By appealing your dependency status, you are asking the Financial Aid Office to override this federal regulation by

relieving your parents of the responsibility of using their resources to pay part of your educational cost. An appeal of this

magnitude will be granted only in extenuating circumstances. Having sufficient resources to pay your own educational

expenses or your unwillingness to seek financial assistance from your parents are not considered extenuating

circumstances for determining dependency status. Neither is the refusal of your parents to provide their data on your

FAFSA or their unwillingness to financially support your education.

If you are considered dependent, but feel that there are circumstances that may warrant reevaluation of your dependency

status, please review the following situations. If one of them describes your situation, check the box and submit this form to

the Financial Aid Office with the required documentation. Please remember that all information that you submit is treated

with the utmost confidentiality.

You have been separated from your parents due to an unsafe home environment

Please submit a detailed



description of your circumstances in your own words. Also submit two sources of documentation, on their

letterhead, from a court, social service agency or respected member of your community (clergy, guidance

counselor, teacher, etc.) acceptable to the Financial Aid Appeals Committee.

You are from a foreign country, but have established permanent residency in the United States, are a refugee or



have political asylum and your parents live outside of the United States. Please submit a detailed description of

your circumstances in your own words. Also submit two sources of documentation, on their letterhead, from the

Department of Homeland Security or a social service agency acceptable to the Financial Aid Appeals Committee.

You have been separated from your parents, but were not in foster care and were not a dependent or ward of the



court, come from a documented background of historical poverty and are living with a relative (who is not your

legal guardian) who is providing your support. Please submit a detailed description of your circumstances in your

own words. Also submit two sources of documentation, on their letterhead, from a social service agency or

respected member of your community (clergy, guidance counselor, teacher, etc.) acceptable to the Financial Aid

Appeals Committee.

I certify under penalty of perjury that the information provided is true and correct to the best of my knowledge.

STUDENT SIGNATURE: _________________________________________

DATE: __________________________

You should also be aware that this form cannot be used to reevaluate your dependency status for Pennsylvania state

grants. If you are a resident of Pennsylvania, you should contact the Pennsylvania Higher Education Assistance Agency

(PHEAA) at 800-692-7392 to request their forms. If you reside in another state and receive a state grant at Holy Family,

you should contact your state’s agency to determine if another form is required.

RETURN COMPLETED FORM TO THE ADDRESS OR FAX NUMBER AT THE TOP OF THIS FORM WITH ALL

REQUIRED DOCUMENTATION. CONTACT US AT THE PHONE NUMBER OR EMAIL ADDRESS ABOVE WITH ANY

QUESTIONS THAT YOU MIGHT HAVE.

Dependency Appeal Form

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