Certification Form Of Separation Or Divorce
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1Southeastern Louisiana University
Office of Financial Aid
SLU 10768
Phone: 985-549-2244
Certification of Separation or Divorce
Hammond, LA 70402
Fax: 985-549-5077
Student's Name:
University ID: W
(required)
INSTRUCTIONS TO STUDENTS and/or PARENTS: You are completing this form to verify your
separation or divorce from your spouse. You are certifying this information to be true and correct. Please
read statement below prior to signing.
I,
, certify that I am
(Separated or divorced)
(Name)
from my spouse
as of
.
(Month, Day, and Year)
(Spouse's name)
I reside at
.
(Physical Address- No P.O. Box)
Comments:
Please read, sign and date.
If you are the parent or the student, by signing this form you agree, if asked, to provide information that will verify the
accuracy of this completed form. This information may include your U.S. or state income tax forms, divorce decree,
utility bills, etc. Also, you certify that you understand that the Secretary of Education has the authority to verify
information reported on this form with the Internal Revenue Service and other federal agencies. If you
purposely give false or misleading information, you may be fined $20,000, sent to prison, or both.
Student's Signature: ____________________________________________
Date: ______________________________
Parent's Signature:
____________________________________________
Date: ______________________________
DO NOT WRITE BELOW
FAA Comments : _________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
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