Proof Of Separation Form 2013-2014 (Page 2 of 2) in pdf

Name of Student’s Spouse or Parent’s Spouse: ____________________________________________________

Complete Physical Address: __________________________________________________________________

Home Telephone Number: ________________________ Cellular phone Number: _______________________

STEP 3: If you do not have a divorce decree OR if you cannot provide a letter from your attorney or

legal aid office, you must submit the following information:

1. Complete this form entirely – do not leave any question blank; write “N/A” if a question does not apply.

2. Reference letters: If you have not consulted with an attorney or legal aid and do not have a court date for

the divorce proceedings or are not pursuing a divorce at this time, you must still provide evidence of your

separation. You must attach a statement which confirms your separation claim from 1 third party persons

(not relatives or friends) who can endorse your statement in their professional capacity on their business

letterhead. For civilians: your pastor, your landlord, your employer, or social services case worker can

provide such a letter. For military: Family Services Office, Unit Chaplain, or the Unit S-1 Personnel Office.

3. Provide all W-2s and Income Tax Returns and/or IRS letters (if applicable) for you and your spouse.

4. Provide copies of documents which are in your name only and your spouse’s name only; such as utility

bills, lease/rental/mortgage documents, and bank statements.

5. A personalized letter from you describing your situation. If you are unable to provide any of the required

supporting documentation you should include the reasons in your letter.

6. Special documentation: As requested by the Financial Aid Office to help us determine if you are physically

and financially separated from your spouse.

7. Your documentation will be reviewed faster if they arrive as a group rather than one at a time – all

documents should have your name and Student ID included. Attach all supporting documentation to this form

and submit together.

********************* You must sign this form in the presence of a notary. ********************

By signing this form, you agree to provide information that will verify the accuracy of your information,

if requested. If you purposely give false or misleading information, you will be referred to the United

States Department of Education’s Inspector General. If you purposely give false or misleading

information in order to qualify for Title IV funds, you may be fined $10,000, sent to prison or both.

Parent's Signature: __________________________________

Date: _______________________

Student's Signature: _________________________________

Date: _______________________

Subscribed and sworn before me this __________ day of ______________________, 20______.

Notary Signature

: _________________________________________________

NOTARY

Print Notary Name: ___________________________________________

SEAL

County: _____________ State: __________________________________

My commission expires: __________________________________

Proof Of Separation Form 2013-2014 Page 2