DIS

2015 - 2016

Panther ID Number
OFFICE OF STUDENT FINANCIAL AID

DETERMINATION OF INDEPENDENCY STATUS

Students Name

Phone Number
Home

Cell

We have received your 2015 - 2016 Free Application for Federal Student Aid (FAFSA). However, we cannot continue to
process your file due to a discrepancy regarding your dependency status. When you completed your FAFSA, you responded
yes to a question(s) that determined that your application be processed as an independent student. However, we do not have
documentation on file verifying such status. In order to resolve this discrepancy, you must complete the chart below.

CHECK THE BOX BELOW THAT APPLIES TO YOU

IF YOU ARE

THEN please attach a copy of the

Emancipated Minor
As of the date you completed your FAFSA, are you or were you an
emancipated minor as determined by a court in your state of legal
residence?
Legal guardian
As of the date you completed your FAFSA, are you or were you in legal
guardianship as determined by a court in your state of legal residence?
Unaccompanied homeless youth
At any time on or after July 1, 2014 did your high school or school
district homeless liaison determine that you were an unaccompanied
youth who was homeless?
Participant of Emergency Shelter Program
At any time on or after July 1, 2014, did the director of an emergency
shelter program funded by the U.S. Department of Housing and Urban
Development determine that you were an unaccompanied youth who
was homeless?
Participant of Basic Center or Transitional Living Program
At any time on or after July 1, 2014, did the director of a runaway or
homeless youth basic center or transitional living program determine
that you were an unaccompanied youth who was homeless or were selfsupporting and at risk of being homeless?

Court Order

Court Order and attached worksheet.

Determination document from high school

or school district homeless liaison

Determination document from director of

program

Determination document from director of

program

NONE OF THESE APPLY

If your answer is NO we will electronically submit a correction to the Federal Processing Center to change your
dependency status on your FAFSA. In addition to this change, you must update your 2015 - 2016 FAFSA with your
parent(s) 2014 information and parental signature. This update can be done online at www.fafsa.ed.gov . We cannot
continue processing your file until this information is received.

Students Signature

Date

FAILURE TO COMPLETE THIS FORM AS DIRECTED WILL RESULT IN THIS FORM BEING RETURNED TO YOU.
Return form to:

OFFICE OF STUDENT FINANCIAL AID

P.O. Box 4040 Atlanta GA 30302-4040

Phone: 404-413-2600 Fax: 404-413-2102
http://sfs.gsu.edu

ENROLLMENT SERVICES CENTER (ESC)

277 Sparks Hall
Hours: Monday Friday from 8:30am to 5:15pm

For students with court appointed legal guardians only.

If you were appointed a legal guardian by a court of law, we need additional information to verify
your independent status. Please complete and return this worksheet along with a copy of the
court order appointing your guardian.
1. Please explain the circumstances surrounding the need for a guardian to be appointed for you.

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
2. When did you begin living with your guardian? _______________________________________
3. Are you still living with your guardian? YES
NO
If your answer is YES, skip question 4. If your answer is NO, complete question 4.
4. If you no longer live with your guardian:
a. When did you leave your guardians home? _________________________________
b. Where did you live after leaving your guardian?
_____________________________________________________________________
c. What are your current living arrangements?
_____________________________________________________________________

CERTIFICATION STATEMENT
I certify that this information is true and correct to the best of my knowledge. Additionally, I
understand that I am responsible for returning all student financial aid monies received due to
inaccurate, false or misleading information provided on this form and/or any other documents
submitted, including tax returns and W-2s.

Students Signature

Date