2015-16 Princeton University Non-Custodial Parent Waiver Request (Page 2 of 2) in pdf

2015-16 Princeton University Non-Custodial Parent Waiver Request Page 2

Did your non-custodial parent pay child support in 2014?

Yes

If yes, indicate total amount paid for you and sibling(s): $___________

Please indicate if the child support was:

Voluntary

Court Ordered

Garnished Wages

If no, indicate the last year child support was paid: ______________

Has your non-custodial parent provided financial support, other than court ordered child support, in the

last 12 months (such as private school, medical or dental bills)?

Yes

If yes, what is the total amount of support provided: $______________

Are you covered under any insurance plans (i.e. health) of your non-custodial parent?

Yes

If yes, what type of insurance?

10. Are there any legal orders limiting your non-custodial parent’s contact with you?

Yes

If yes, please explain and attach documentation to this form.

Certification

Members of the University community are expected to be honest and straightforward in their official dealings with

University processes, activities, and personnel. This obligation includes honoring contracts and agreements and

providing accurate information on official forms and documents as well as to official University personnel, offices,

and committees. Deliberate violations of this provision will be considered serious offenses; subsequent violations, or

systematic violations in the first instance, will be considered extremely serious.

(1.1.4 Honesty and Cooperation in

University

Matters,

Rights, Rules, Responsibilities, 2014 edition)

We certify that the information on this statement is complete and accurate. We understand that misrepresentation

or falsification on any financial aid documents will result in penalties to be determined by Princeton University.

Custodial Parent signature: ______________________________________ Date:_____________________

Student signature: _____________________________________________ Date:_____________________

2015-16 Princeton University Non-Custodial Parent Waiver Request Page 2