CAYUGA
Financial Aid Office ·
Separated
Student
Name_________________________________________ Social
Security #____________________
Banner
ID Number C________________________________
You
indicated on your financial aid application that you (or your parents) are
separated. In order to continue
processing your financial aid application, we need some additional information. Please complete this form and return to the
Financial Aid Office as soon as possible.
Additional documentation may be requested to verify information.
Dependent
Students
Name
of Custodial Parent ____________________________________________________________
(the parent whose income was reported on the FAFSA)
Address
of Custodial Parent ____________________________________________________________
____________________________________________________________
Name
of Non custodial Parent ____________________________________________________________
Address
of Non custodial Parent ____________________________________________________________
____________________________________________________________
Date
of Separation ____________________________________________________________
Was
a joint income tax return filed for 2011? Yes No
(If “yes”, please attach a
copy of a signed 2011 tax return and 2011 W-2’s for the parent whose income was
reported on the FAFSA).
Independent
Students
Name
of spouse ____________________________________________________________
Address
of spouse ____________________________________________________________
____________________________________________________________
Was
a joint income tax return filed for 2011? Yes No
(If “yes”, please attach a
copy of your signed 2011 tax return and your 2011 W-2’s).
Student
Signature___________________________________________Date_________
Return to: Financial Aid Office at Cayuga Community College 1/11