· 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 ___________________________________________________________________
Cayuga ID# _____________________________________________
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
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