Chowan University Financial Aid Office One University Place Murfreesboro, NC 27855 Phone: 252-398-6535 Fax: 252-398-6513 Email: finaid@chowan.edu Financial Aid Office 2018-2019 Dependency Status Request Form & V1 Priority Dates Returning Students February 28, 2018 New Students April 30, 2018 In rare instances, a student may have extenuating that are not identified when completing the Free Application for Federal Student Aid (FAFSA). This request process gives the student the ability to state difficult that may permit a change in dependency status. Dependency Status: Circumstances that DO NOT justify a dependency override: Parents refuse to contribute to the student s education Parents unwillingness to provide information on the FAFSA or for verification Parents do not claim the student as a dependent for income tax purposes Student does not live with their parents Student demonstrates total self-sufficiency Circumstance Supporting Documents Resources to Consider and Contact Death of Both Parents Death of custodial parent and nonexistent relationship with surviving parent Lack of contact and relationship with either parent Not living with parents due to estrangement, abandonment, incarceration or mental incapacity Not living with parents due to unsafe home environment Since turning 13, I have been: in foster care, or considered a ward of the court. I am in legal guardianship or considered an emancipated minor. I am considered: a homeless youth, at risk of being homeless, or an unaccompanied minor since July 1, 2017. Copies of each death certificate, obituary, or funeral service Copies of death certificate, obituary, or funeral service Personal statement and two (2) third party an unsafe home environment Documents supplied by the McKinney-Vento Act Online newspapers, funeral home records, family records Online newspapers, funeral home records, family records Counselor, minister, attorney, educator, doctor or social worker, medical records, medical records High school or school district homeless liaison, director of emergency shelter or transitional housing program, a director of a runaway or homeless youth basic center Please proceed to page 2 Section A
Financial Aid Office 2018-2019 Dependency Status Request Form & V1 Your 2018-2019 Free Application for Federal Student Aid (FAFSA) has been received and was selected for review in a process called verification. The law states that before awarding Federal Student Aid, we must confirm the information you reported on your FAFSA. To verify correct information was reported, we will compare your FAFSA with the information in this packet and with any other required. If there are differences, we will update your FAFSA. If you have questions about verification, contact us as soon as possible so that your financial aid will not be delayed. Additional information may be required. A. STUDENT S INFORMATION Student s Name Date of Birth SSN XXX-XX- Permanent Mailing Address City, State Zip Code Student s Cell Phone Home Phone B. HOUSEHOLD INFORMATION & FORMS From July 1, 2018 through June 30, 2019 INDEPENDENT STUDENT List yourself in the household Student Documents to Gather & Return Provide two letters of support from a professional knowledgeable third party. * Your 2016 Federal Tax Transcripts & Schedules Your 2016 W-2 s Verification of Non Tax Filing Letter - If you did not work or file taxes. Request from IRS using form 4506-T https://www.irs.gov/forms-pubs/about-form-4506t *A knowledgeable third party resource may be one of the following: counselor, minister, attorney, educator, doctor, social worker, your high school or school district homeless liaison, director of an emergency shelter or transitional housing program funded by the U.S. Department of Housing and Urban Development, a director of a runaway or homeless youth basic center, or a transitional living program, etc.) Full Name Age Relationship College/University Self Chowan University Enrolled at least Half Time(yes/no) C. HOUSEHOLD BENEFITS Must be completed by all students. Please check if any of the benefits listed below were received in 2016 or 2017. Medicaid or Supplemental Security Income (SSI) Yes No Food Stamps (SNAP) Yes No Free/Reduced School Lunch Yes No Temporary Assistance for Needy Families (TANF) Yes No Women, Infants and Children (WIC) Yes No
STUDENT NAME: CHOWAN ID Student Information Section D. STUDENT - Marital Status and/or Tax Filing Status - All Students please complete this section. What is your marital status as of today? Never Married (Only select this option if you have NEVER been legally married) Divorced or Separated Married or Remarried Widowed For 2016, have you (the student) completed your IRS income tax? (Please check one box) What income tax did you file or will you file for 2016? No, because I did not work No, because I worked, but was not required to file a Yes, I have already completed my I will file but have not yet completed my IRS 1040 IRS 1040A or 1040 EZ A foreign tax (Please only check one box) For 2016, what is or will be your tax filing status according to your tax? (Please only check one box) I do not know my filing status Single Head of household Qualifying widower Married filed joint Married filed a separate E. STUDENT ASSET INFORMATION As of Today Before we can process your verification, you MUST complete the asset section below. Write 0 for zero amounts. As of the Date you complete this form Amount in cash, savings and checking Net Real Estate (do not include your home) Net Investments (stocks, bonds, CDs, etc.) Net Business Worth and or investment farms (Don t include a family farm or family business with 100 or fewer full time employees) Student Please proceed to page 4 Section F
STUDENT NAME: CHOWAN ID Untaxed Income Section ALL Students Complete DO NOT LEAVE BLANK F. UNTAXED INCOME Calendar Year 2016 If you indicated in Section D that the student, spouse, or either parent DID NOT file a 2016 Federal Tax Return, this individual must submit Verification of Non Filing Letter from the IRS. Use Form 4506-T from the IRS if applicable. Please provide information about any other resources, benefits, or funds received by the student or members of the student s household. For Non-Tax Filers some form of assistance is required to be reported in this section. This may include items that WERE NOT required to be reported on the FAFSA. Write 0 for zero amounts if not applicable. Person/Organization Providing Support List Monthly Amount Received by Student Alimony Received Child Support Received Clergy (housing, clothing, food or cash) Unemployment Compensation Disability from Social Security Administration (include amounts for dependents) Please refer to your copy of SSA-1099 Disability (Private Company) Supplemental Security Income (SSI) Please refer to your end of the year statement Non-educational VA Benefits Self-Employment (Not reported on taxes) Financial Assistance from family members Source: ex. Grandmother Jane Doe paid for cell phone ex. $70/month Source: PLEASE SUBMIT ALL SUPPORTING DOCUMENTS Please proceed to page 5 Section G
STUDENT NAME: CHOWAN ID #: G. PERSONAL STATEMENT Your Personal Statement Should Include ALL of the following: Explain, in detail, why you should be considered independent for the 2018-2019 school year. You must explain why BOTH your parents are unavailable to participate in the Financial Aid Process. Justify claims of self-support should be documented in Section G. If you need more space, please attach an additional page. Make sure to include your name and last 4 digits of your social security number. All information will be kept private within your Financial Aid file and will only be accessible by Financial Aid staff and University staff in which we deem necessary. Reason why Father/Parent 1 is unavailable to participate: Reason why Mother/Parent 2 is unavailable to participate: H. Certification and Signature If you the student, by signing below you certify that all of the information you provided is true and complete to the best of your knowledge and you agree, if asked, to provide information that will verify the accuracy of your completed form. By signing below, I authorize the Financial Aid Office to perform necessary electronic corrections to the FAFSA on my behalf. I realize that any false statement or failure to give proof when asked may be cause for denial, reduction, withdrawal, and/or repayment of my financial aid. I also understand if I purposely give false or misleading information I may be fined, sentenced to jail, or both. (Student s Signature) For office use only: Please to: Chowan University Financial Aid Office One University Place Murfreesboro, NC 27855 Fax 252-398-6513 * Email finaid@chowan.edu * Phone 252-398-6535 (Date) Approved Denied Date FAA