College of DuPage
Office of Student Financial Assistance
2015-2016 No Parent Information
Last Name:
First Name:
Student ID:
Student’s Current Address:
This form documents the lack of parental data on the Free Application for Federal Student Aid (FAFSA) so as to qualify
for a Federal Direct Unsubsidized Loan. Submit this completed form with all required documents. Additional
documentation may be requested after submitting the form.
SECTION A: STUDENT CERTIFICATION
□
What is your current living arrangement?
With Parents Do you pay rent?
With Roommates or Relatives
□
Yes. If yes, submit proof of rental payments
On Own
No
To accept my Federal Direct Unsubsidized Loan I must attend a Smart Borrowing Loan Presentation. Register
through myACCESS by following instructions on our website at http://www.cod.edu/financial_aid_events
□ I am a Freshman (less than 30 earned credit hours) – eligible for $5,500 for the academic year.
□ I am a Sophomore (30 or more earned credit hours) – eligible for $6,500 for the academic year.
NOTE: Failure to submit supporting documentation will delay the processing of this status and the determination for
an Unsubsidized loan.
□
My parents are no longer providing support and are signing the Parent Certification on Page 2. (Continue to Page 2.)
□
My parents will not sign this form.
My parents currently live at:
(Enter current address)
If your parent(s) will not sign this form, you will need to attach a typed, signed statement from a third party that
is able to explain the situation. This statement should be from an adult who has direct knowledge of the current
situation or a professional from whom you have sought assistance and include his/her contact information.
Professionals include guidance counselors, doctors, lawyers, family counselors, social workers, law enforcement
officers, clergy members, etc.
Verification statement provided by:
Printed Name
Relationship to Student
Verification Statement is attached.
Turn over for Parent Certification & Signature and Student Signature on Page 2.
2015-2016 No Parent Information
02/25/15
Student’s Name:
ID:
SECTION B: PARENT CERTIFICATION
I, the parent of
do not provide financial support for my child.
Student’s Name
I, the parent currently live at:
(Enter current address)
By signing this form, I am certifying that I have stopped providing financial support, which includes but is not limited to,
any payment of educational costs, cash, and non-cash support to the student, such as room/board, payment of bills on
child’s behalf, health insurance, etc. I also acknowledge that I will be ineligible to apply for a Parent PLUS loan on behalf
of my child.
I,
, certify that I am no longer providing any financial support for my
(Parent Name – PRINT)
child and will not provide financial support for my child in the future, effective
Date financial support ceased
.
I refuse to provide parental data for the 2015-2016 FAFSA.
Parent Signature
Date
By signing this form, I acknowledge that I will be ineligible to receive any other Title IV Financial Aid (Grants, Subsidized Loans,
Federal Work Study, etc.) if this form is approved. I further certify that all information on this form is true, complete and accurate.
Upon request I agree to provide additional proof of the information reported on this form. Warning: If you purposely give false or
misleading information, you may be fined up to $20,000, sent to prison, or both.
Student Signature
Date
Please return this form to:
College of DuPage, Office of Student Financial Assistance – SSC 2220
425 Fawell Blvd., Glen Ellyn, IL 60137 FAX (630) 942-2151 EMAIL: financialaid@cod.edu
The college will not discriminate in its programs and activities on the basis of race, color, religion, creed, national origin, sex, age, ancestry, marital status, sexual
orientation, arrest record, military status or unfavorable military discharge, citizenship status, physical or mental handicap or disability (Board Policy 5010; 20-5).
OSFA USE ONLY
□ Approved
Reject Status = X: Y
N
FAFSA Housing: 1 –
On Campus
□ Denied
Comment Code: 295
2 – With Parents
Budget:
300
□ Committee Review
SC Flag: 1
3 – Off Campus
Loan Eligibility: Freshman
Documentation Received:
Notes:
FA Representative Signature:
Committee Review & Decision: Yes
4
Date:
No
Reason:
Sophomore