Fillable Printable Divorce Verification Form - Edgecombe Community College

Divorce Verification Form - Edgecombe Community College

Tarboro campus: 2009 W. Wilson St., Tarboro, NC 27886 • Phone: (252) 823-5166 • Fax: (252) 823-6817

Rocky Mount campus: 225 Tarboro St., Rocky Mount, NC 27801 • Phone: (252) 446-0436 • Fax: (252) 985-2212

Confirmation of Separation or Divorce

STUDENT INFORMATION:

____________________________ _______________________ ______ _______________________

Last Name First Name MI SSN or Student ID

Please select one of the following:



I am aDependent student (I provided income and asset information for myself and my parent on the

FAFSA). Your parent must complete the information below.



I am an Independent student (I did not provide parent income and asset information on the FAFSA).

Student must complete the information below.

I, ______________________________, am currently



separated or



divorced from my spouse,

_______________________________________ since ______________ _________.

Name of Spouse Month Year

My address: ______________________________________________________________________________

Street Address

______________________________________ State: _____________ Zip Code:____________

City

Spouse address: ____________________________________________________________________________

Street Address

____________________________________ State: ____________ Zip Code: _____________

City

_____________________________________________________________________

Student Signature Date

_____________________________________________________________________

Parent Signature (if applicable) Date