· CAYUGA COMMUNITY COLLEGE

Financial Aid Office · 197 Franklin Street, Auburn NY 13021· FAX 315-252-2185

Auburn - 315-255-1743 ext. 2470 · Fulton 315-592-4143 ext. 3004

 

Separated

 

Student Name  ___________________________________________________________________

 

C-Number  _____________________________________________

 

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 the following form.  Once you have entered the necessary information online, you will need to print the form, provide all required signatures and return it to the CCC Financial Aid Office.  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 2012?             Yes                  No

If “yes”, please attach a copy of the 2012 IRS tax transcript and 2012 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 2012?             Yes                  No

If “yes”, please attach a copy of your 2012 IRS tax transcript and your 2012 W-2’s.

 

 

Student Signature______________________________________________________   Date_______________

 

Return this form along with all required documentation to the Financial Aid Office at CCC

 

1/13