NI HAO ASUNA

DECLARATION OF SEPARATION/DIVORCE
I, __, do hereby swear/affirm that I no longer consider myself to be the
(Print Student Name)
wife/husband of _____.
(Print Former Spouse Name)
I currently reside at
__.
Address City State Zip
My former spouse currently resides at
__.
Address City State Zip
We have not co-habited since ____/__ and we have no plans to do so in the future.
Month / year
Applicant/Parent Signature Date
Check only one (1) option below:
 I am separated and have attached all copies of W-2’s from both the student and spouse. I give
permission to the Financial Aid Office to separate income and correct my FAFSA, if required. I
have completed the income Separated/Divorced Income Verification pages included with this form.
 I am separated and have already separated/made corrections to the household income on the
FAFSA.
 I am divorced and have attached all copies of W-2’s from both the student and former spouse. I give
permission to the Financial Aid Office to separate income and correct my FAFSA, if required. I
have completed the income Separated/Divorced Income Verification pages included with this form.
 I am divorced and have already separated/made corrections to the household income on the FAFSA.
Please attach a copy of your divorce, separation, or interlocutory agreement. Failure to do so may
delay further processing of your aid application.