Petition For Dependency Override Form - Office Of Student Financial Assistance - 2017-2018

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Office of Student Financial Assistance
2017-2018
P
D
O
ETITION FOR
EPENDENCY
VERRIDE
Name:
Date: _________________________
Address:
________
UCF ID: _______________________
City:
State/Zip:
________________________
Phone #:
Email Address:
.
Do not submit original supporting documents; copies are acceptable. Documents will be shredded after scanning
Parent 1 Name:
Address:
Phone #:
Parent 2 Name:_
Address:
Phone #:
When did you last live with your parents? ……………………………………………………_____________________
When did your parents last provide any monetary support for you?................................____________________
Who do you live with at the present time?.............................................................................................____________________
When was the last time you had contact with your parents? ……….Parent 1 - Date
Parent 2 - Date
How often do you have contact with your parents?...........................Parent 1
Parent 2
Did you file the 2017-2018 FAFSA?.......................................................................
Yes
No
If yes, Date filed
Have you previously applied for Dependency Override at UCF?
Yes
No
........................
If yes, was your application …………………………… -approved or
-denied.
Date of Application
Reason for Dependency Override Petition
Incarcerated Parent(s)
Abuse
Parental Abandonment
Custodial Parent Deceased, Other Parent Meets One or More Categories
Homeless or At Risk of Homelessness
Other
Please attach an explanation of the extenuating circumstances and history of your parental situation,
why you no longer live with your parents, and why they no longer support you. In addition, you are required to include information regarding
the whereabouts of both of your biological /adoptive parents within the last five years. Each extenuating circumstance mentioned in your
explanation must be supported by applicable documentation (such as police reports or arrest records).
I certify that the information provided on this form is true and correct. I also understand that by signing this form, I authorize the UCF Office
of Student Financial Assistance to contact any third-party reference and verify any information supplied on this form.
Student’s signature
Date
For school use only
( ) Pending Date
( ) Approved Date
( ) Denied Date
Doc/s
Reason
Reason
Committee Signatures:
Date
Letter sent
Date
1.
2.
3. _
OSFA Administrator Comments
Office of Student Financial Assistance
Millican Hall, Room 120  Orlando, FL 32816-0113  Phone: (407) 823-2827 Fax: (407) 823-5241
An Equal Opportunity and Affirmative Action Institution
F_ind1718 – Rev. 09/16

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