Dependency Review Form 2014-2015

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 2012: $________ 2013: $_______ est. 2014: $______
2b. Student's total other resources 2012: $________ 2013: $_______ est. 2014: $______
3. Was student claimed by parent(s) or legal guardian in: 2012: $________ 2013: $_______ est. 2014: $______

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

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financialaid@esc.edu

Fax: 518-581-2782

Mailing Address: 
Empire State College
Financial Aid
111 West Avenue
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

Announcements

Aid for Part-Time Study funding has become available again for the 2014 spring term, which falls within the 2013-2014 academic year. You must apply for APTS for 2013-2014 in order to receive a 2014 spring award.

The priority deadline to apply for financial aid for 2014-2015 is April 1, 2014.