FAO - Independence Reaffirmation (PINREA)

Academic Year

2021-2022 (2122)
Academic Year
June/July 2021 (SUMMER),
August 2021 (FALL) or
January 2022 (SPRING) Semesters ONLY

2022-2023 (2223)
Academic Year
June/July 2022 (SUMMER),
August 2022 (FALL) or
January 2023 (SPRING) Semesters ONLY
Form Name *
Student ID # *
Must be 9 characters. Currently Entered: 0 characters.
MUST start with A
Name Name * First Last
Email *
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
The Office of Financial Aid must reaffirm each year that the circumstance(s) still exist and that the decision is still justified.

PLEASE READ
I, the student, in a previous year I was approved for Independent Status by the Office of Financial Aid at SUNY Orange.

I understand that according to Federal regulations, not only does the independent status decision not carry over from one school to another, they may not carry from year to year.

At this time I formally ask the Office of Financial Aid to accept my petition for Independence Reaffirmation. *

The Office of Financial Aid must reaffirm each year that the circumstance(s) still exist and that the decision is still justified.

PLEASE READ
I, the student, in a previous year I was approved for Independent Status by the Office of Financial Aid at SUNY Orange.

I understand that according to Federal regulations, not only does the independent status decision not carry over from one school to another, they may not carry from year to year.

At this time I formally ask the Office of Financial Aid to accept my petition for Independence Reaffirmation. I, the student, reaffirm that the circumstances I used to support my petition for Independence Status, supported by the documentation provided in a previous academic year, still exist. There has been no change to circumstance.
Provide supporting documentation.

SUNY Orange will only accept the following file types: pdf, jpeg, bmp, gif, doc, jpg, png *

Attach Files
Electronic Certification Agreement

By providing your “electronic” signature, student ID #, and by selecting the “Accept" button, you consent that you are signing this form electronically.

You agree your electronic signature is the legal equivalent of your handwritten signature. By selecting "I Accept" using any device, means or action, you consent to the terms and conditions of this form and its intent. You further agree that your signature on this document (hereafter referred to as your "e-signature" or "e-sign") is as valid as if you signed the document in writing.

You also agree that no certification authority or other third party verification is necessary to validate your e-signature, and that the lack of such certification or third party verification will not in any way affect the enforceability of your e-signature or any resulting agreement between you and the SUNY Orange Financial Aid Office.

You are also confirming that you are the student authorized to e-sign this form and this constitutes your agreement to be bound by the terms and conditions as they exist on the date of you e-sign this form.
Student Accept: *

Student Accept: I, the student, consent that all of the information reported is complete and correct.
Draw your signature into the box below. *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Student ID# *

MUST start with A
Date Date * / MM / DD YYYY
WARNING:

If you purposely give false or misleading information on the worksheet, you may be fined, be sentenced to jail, or both.

FAO - Independence Reaffirmation (PINREA)

FAO - Independence Reaffirmation (PINREA)

Electronic Certification Agreement

WARNING: