4505 Maryland Pkwy, Campus Box 452016, Las Vegas NV 89154-2016

Fax (702) 895-1353 · Phone (702) 895-3424 · · Twitter: @UNLV_FinAidSch

2013- 2014 Dependency Status Appeal Renewal

Student’s Information --DO NOT LEAVE ANYTHING BLANK
Student Name: ______NSHE ID: ______
TO BE COMPLETED ONLY IF:
  1. You filed a 2012-2013 Dependency Status Appeal Form and it was approved, AND
  1. You submitted a 2013-2014 FAFSA, your status is still dependent* on the FAFSA, and you are still unable to provide parent information (you MUST submit your 2013-2014 FAFSA before submitting this appeal form); AND
  1. You can still document an extenuating circumstance which would warrant a Dependency Override. For example, if your previously approved circumstances are still present.

INSTRUCTIONS
  1. Complete all steps listed on Page 2 of this form, providing COPIES of all requested items. NOTE: Financial Aid and Scholarships does not provide copying services. Any originals will not be returned. Incomplete appeals will be denied.
  1. Submit all items to UNLV Financial Aid & Scholarships (contact information provided above). Incomplete appeals will automatically be denied.
Due to the high volume of traffic our office receives during the beginning of each semester, we will not process or accept appeals during the following dates:
FALL 2013: August 12, 2013 through September 6, 2013
SPRING 2014: January 6, 2013 through January 31, 2013
You will be notified of the decision by Rebel Mail and via the MyUNLV Communication Center within 6 weeks of receipt of ALL requested items.
Certification
By signing below, I certify that: 1) I am enclosing the requested documents and ask that the Financial Aid Appeals Committee consider my request for independent status; 2) this information is true and accurate; 3) I will provide any additional information requested; 4) I understand my appeal is incomplete until all requested information is received by the UNLV Financial Aid & Scholarships Office; and 4) I understand any false information will be cause for the denial, reduction and/or repayment of financial aid and may subject me to a fine, imprisonment or both.
Student’s Signature: ______Date ______
Documents Required / Information to be Included
Letter from Student /
  • Explain your CURRENT relationship with both of your parents.

Dependency Status Appeal Form /
  • Be sure to complete and sign page 1 of this appeal form.

File 2013 - 2014 FAFSA /
  • If you have already filed a 2013-2014 FAFSA, you do not need to file another one.
  • If you have not already filed a FASFA, complete the 2013-2014 FAFSA providing only your information and selecting the option to submit your FAFSA without parent information or signature. Go to to file.

2013-2014 Verification Worksheets /
  • Complete and sign the 2013-2014 Verification Worksheets. The worksheets are included as part of this appeal form.

2012 IRS Tax Return Transcript (if you filed) or 2012 W-2 Forms (if you worked but did not file a tax return) /
  • Attach a signed copy of the IRS Tax Return Transcript()OR,
  • Attach copies of all 2012 W-2 forms if you worked but did not file a tax return

4505 Maryland Pkwy, Campus Box 452016, Las Vegas NV 89154-2016

Fax (702) 895-1353 · Phone (702) 895-3424 · · Twitter: @UNLV_FinAidSch

2013- 2014 Verification Worksheet Version 1

Your 2013-2014 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. You and one parent (if dependent)must complete and sign this worksheet, attach any required documents, and submit the form along withany other additional information required by the Financial Aid & Scholarships Office. See: for more information.
  1. Student’s Information

Last Name: ______First Name: ______MI: ______
NSHE ID:______
  1. Family Information- Please check the box that indicates your current status

□ Dependent- A student is considered dependent if he/she was required to provide parental data on the FAFSA / □ Independent- A student is considered independent if he/she was not required to provide parental data on the FAFSA
Please include in the table below:
  • You and your parents/stepparents(who provide more than half of your financial support)
  • Your parent/stepparents’ dependent children, if your parent/stepparents’ will provide more than half of their support, or if the children would be required to provide parent information applying for financial aid
  • List other people as part of your household only if they now live with your parents AND theyprovide more than half of their support AND will continue to provide more than half their support from July 1, 2013 through June 30, 2014.
  • Provide the name of the college for any household member who will be attending atleast half time between July 1, 2013 through June 30, 2014
/ Please include in the table below:
  • You and your spouse, if married
  • Your dependent children, if you will provide more than half of their support
  • List other people as part of your household only if they now live with you AND youprovide more than half of their support AND will continue to provide more than half their support from July 1, 2013 through June 30, 2014.
  • Provide the name of the college for any household member who will be attending atleast half time between July 1, 2013 through June 30, 2014

Full Name / Age / Relationship / Full College Name
(do not include parent enrollment)
Self (student) / University of Nevada, Las Vegas
  • Attach additional sheet if necessary to include additional members of the household

  1. Income Information- check ONE

Student/ (spouse, if married) / Parent(s)–If Dependent Student
□ I/we have used the IRS Data Retrieval Tool at Skip to section E / □ I/we have used the IRS Data Retrieval Tool at Skip to section E
□ I/we DID NOTuse the IRS Data Retrieval Tool. Attach a signed copy of the IRS Tax Return Transcript().
Skip to section E
□ I/we certify that I/we did not file, will not, and am/are not required to file a 2012 U.S. Income Tax Return. GO to Section D / □ I/we DID NOTuse the IRS Data Retrieval Tool. Attach a signed copy of the IRS Tax Return Transcript().
Skip to section E
□ I/we certify that I/we did not file, will not, and am/are not required to file a 2012 U.S. Income Tax Return. GOto Section D
  1. Income Information for Non-Filers ONLY

If you are not required to file a 2012 U.S. Income Tax Return, list your employer(s) and any income received in 2012(attachall w-2 Forms or other earning statements such as 1099-Miscellaneous). If NO ONE in the household (of those listed in Section B. Family Information of this form) earned income by working, FULLY complete and ATTACH the 2013-2014 Low Income Clarification Worksheet. DO NOT LEAVE THIS BLANK, if not applicable, enter “N/A”
Employer Name
Note: in most occasions, earning above $5,800 requires a Tax Return to be filed / Student/ Spouse (if married)
2012 Amount / Parent(s) – if dependent2012 Amount
1.
2.
3.
  1. Supplemental Nutrition Assistance Program (SNAP) Benefits

*Please select YES or NO. DO NOT leave anything blank.
Didany members of your stated household receive food stamps, State Supplemental Nutrition Assistance Program (SNAP) in 2011and/or 2012? / □ Yes □ No
Please sign thestatement in the area provided below by you, or your parents if you are dependent, affirming benefits were received by someone in the household during 2011 and/or 2012.
I, ______, affirm that benefits were received by someone in the household during 2011 and/or 2012.
(student/parent)
  1. Child Support Paid

On your 2013-2014 FAFSA, you have stated that someone in your household paid child support due to a COURT MANDATED requirement in 2012. Please complete the following information. DO NOT LEAVE THIS BLANK, if not applicable, enter “N/A”
Child Support you PAIDdue to a COURT-MANDATED requirement (attach a separate page if needed) in 2012
Child’s Name / Name of person paying support / Name of person receiving child support / Student/ Spouse (if married)
Annual Amount / Parent(s) – if dependent
Annual Amount
/year / /year
/year / /year
/year / /year
/year / /year
  1. Untaxed Income

*Please select YES or NO. DO NOT leave anything blank.
Sources of Untaxed Income / Student/ Spouse (if married)
2012 Amount / Parent(s) – if dependent 2012 Amount
Are the IRA Distributions from your IRS form 1040 or 1040A a rollover amount? / □ Yes □ No / □ Yes □ No
Are the Pension Distributions from your IRS form 1040 or 1040A a rollover amount? / □ Yes □ No / □ Yes □ No
  1. Grants/Scholarships

If you received grants/scholarships for the year 2012-2013 for which you reported on your 2012 federal tax returns, please list the amount here: $______
  1. Sign this Worksheet

By signing this worksheet, I certify that all information reported on this worksheet is complete and correct under penalty of perjury.
______
Student Signature Date Parent Signature (if dependent) Date