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Office of Student Financial Assistance
Unusual Circumstance Application Reference Form
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First Name:
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Last Name:
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Student ID:
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SpaceSpace
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Academic Year:
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Provide a detailed statement explaining your view of the applicant’s unusual circumstance which has prompted a request to change their dependency status for financial aid purposes. Include information regarding the applicant’s relationship with their parents, why it would be unreasonable to assess the parent’s ability to contribute to the applicant’s education, and any additional information which will distinguish the applicant’s situation as out of the ordinary.
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I certify all of the information on this form is true and complete to the best of my knowledge. I also understand that I may be contacted if further information is needed. I understand that the penalty for providing false or misleading information is a $20,000 fine, a prison sentance, or both.
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Please read the Disclosure / Consent before you sign your form electronically.
Please type your full name in the signature box. Typing your name signifies you are completing this form using an electronic signature. By signing electronically, you are certifying that you have read and understand the Disclosure/Consent and agree to electronically sign. You also agree to receive required disclosures or other communications related to this transaction electronically.
To continue with the electronic signature process, please enter your name and click the "Sign Electronically" button to save your information and submit your electronic signature.
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