Noncustodial Parent Waiver Petition Form
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2Submit this form:
Online at
Fax: 607-255-6329
Noncustodial Parent Waiver Petition
Requests based solely on your noncustodial parent’s unwillingness to contribute or submit application materials are
not considered.
If your Noncustodial Parent Waiver Petition is denied, your noncustodial parent’s financial information will
be required for your application for financial aid this year and every year you apply for need-based financial
aid.
STUDENT INFORMATION
Name:
Applying for the 20
- 20
academic year
Date of Birth:
Permanent Address:
Biological or adoptive parents’ marital status (check all that apply):
Divorced
Separated
Never Married
date (month & year)
date (month & year)
Mother remarried
Father remarried
date (month & year)
date (month & year)
NONCUSTODIAL PARENT INFORMATION
Noncustodial Parent Name:
Telephone Number:
Occupation:
E-mail Address:
Address:
STUDENT STATEMENT
Please provide a brief explanation regarding your extenuating circumstances with your noncustodial parent to help us
better understand your situation. Attach any legal orders (i.e. restraining order, police report, or divorce decree) or any
other supporting documentation that helps explain your situation.
I certify that all the information provided on this form is true and complete to the best of my knowledge. I understand that if my waiver
request is approved, and the relationship with my noncustodial parent changes during my time at Cornell, I will notify the Office of Financial
Aid and Student Employment of the change. I understand I may be required to submit his/her information at that time.
Student’s Signature ________________________________ Date _____________
Revised 8/6/2015
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