· 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______________________________  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 Other Parent              ________________________________________________

Address of Other Parent           ________________________________________________

                                                ________________________________________________

Date of Separation                    ___________________________

Was a joint income tax return filed for 2007?                 Yes                  No

(If “yes”, please attach a copy of a signed tax return and 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 2007?                 Yes                  No

(If “yes”, please attach a copy of your signed tax return and your W-2’s.)

Student Signature___________________________________________Date_________

Return to: Financial Aid Office, Cayuga Community College

01/08