Dependency Review Form 2017-2018

PLEASE PRINT

Student Section

Student's Name:______________________________________SS#________________

Permanent Address:______________________________________________________

Email Address:_________________________________________________________

1a. Student's marital status:________ 1b. Date of marital status:___________
2a. Student's total earned income 2015: $________ 2016: $_______ est. 2017: $______
2b. Student's total other resources 2015: $________ 2016: $_______ est. 2017: $______
3. Was student claimed by parent(s) or legal guardian in: 2015: $________ 2016: $_______ est. 2017: $______

4. Explain circumstance which justify treatment of student as self-support (attach other sheets as necessary):

_____________________________________________________________

5. Attach documentation; describe below.

Nature of documentation:___________________________________________________

Source:__________________________________________ Date received:__________

Nature of documentation:___________________________________________________

Source:__________________________________________ DaterReceived:__________

Student signature:_________________________________________________________

School Section:

6. Action: Approved:_____________ Denied:_____________ Date:___________

Additional information requested:__________________________________Date requested:______

Staff:_________________________________________

Mail or fax this form along with documentation of your circumstances to:


Financial Aid Office
Empire State College
111 West Ave.
Saratoga Springs, NY 12866

FAX: 518 581-2782
Phone: 518 587-2100

Contact us

financialaid@esc.edu

Fax: 518-581-2782

Mailing Address: 
Empire State College
Financial Aid
111 West Ave.
Saratoga Springs, NY 12866

Questions? Contact the Student Information Center at 518-587-2100 or 800-847-3000.

FAFSA Info

Code: 010286
Name: SUC Empire State College

TAP Codes

Undergraduate: 0913
Graduate: 5680 (for graduate students applying for Veteran Tuition Awards)

Announcements

Students planning to attend 2016-2017 should complete the Free Application for Federal Student Aid for 2016-2017.   Students wishing to get an early jump on applying for financial aid for 2017-2018 (enrollments beginning on or after May 15, 2017) can do so by submitting the 2017-2018 FAFSA.

Take the Next Step

Ready to advance your education and career? There’s no time like the present. Apply now, or learn more about SUNY Empire at one of our information sessions.