Fillable Printable Separation Verification - Texas
Fillable Printable Separation Verification - Texas
Separation Verification - Texas
Western Texas College
Financial Aid
6200 S. College Ave
Snyder, TX 79549
Separation Verification
You have been asked to complete this form because you indicated a separated marital status for either yourself or your parents and
did not provide legal court documents for divorce proceedings. Please answer the following questions regarding the marital status
in question.
_____________________________________________________________________________________________
STUDENT NAME (Please Print) Student ID #
1. Spouse’s legal name: ________________________________________ SSN#:______________________
2. Spouse’s current residential address:________________________________________________________
City:_______________________________St______Zip____________
3. Spouse’s employer’s name: _____________________________________________________
Address_________________________________City_______________________St______Zip_____________
4. Date of Marriage: ___________________________ Date of Separation:___________________________
5. Federal Tax Information: When was the last time you and your spouse filed a joint tax return:
[Check one] Year 20___ ___ Never Filed Joint
6. Benefits Received: Since your separation, do you receive child support or TANF? _______ Yes________ No
7. What is the monthly rent/mortgage and utility amounts? ____________ Who pays for this? _____________
If you receive public assistance or monetary assistance from family, provide proof.
8. Divorce Intentions: Do you intend to proceed with the divorce? _________ Yes _________ No
If yes, proceed to question 9. If no, skip question 9 and go to question 10.
9. Court Date: Do you have a court appearance for the divorce proceedings? ________ Yes _________ No
If yes, provide our office with a copy of the court document submitted. If No, provide a letter from
the attorney representing you for the divorce hearing.
10. Reference Letters: If you do not have a court date for the divorce proceedings or are not pursuing a divorce at this
time, and you still want to provide evidence of your separation, you must attach a statement, which confirms your
separation claim from a third party (not a relative nor a friend) on their letter head who can endorse your statement in
their professional capacity. For example, your pastor, your marriage counselor, or your attorney can provide such a letter.
If you do not provide this necessary letter, you will be required to provide your spouse’s information.
11. Testimonials: Provide a list of three people (name, address, office phone number) other than relatives that know of
your marital situation.
1. _____________________________________________________________________________
2. _____________________________________________________________________________
3. _____________________________________________________________________________
12. W-2’S are required in order to continue processing your file, if you and your spouse filed joint tax return.
13. Special documentation: As requested by Student Financial Aid Office.
By signing this form, you agree to provide information that will verify the accuracy of your information, if
requested. If you purposely give false or misleading information, you will be referred to the Inspector General and
you could be fined $10,000.00, and or sent to prison.
STUDENT SIGNATURE: ______________________________________ DATE: _______________________
Western Texas College
Financial Aid
6200 S. College Ave
Snyder, TX 79549
As per HB 1922 (Subtitle A , Title 5, Government Code, Chapter 559), it is the policy of the state that an individual is entitled , on request, to receive,
review and /or correct any information about the individual , which has been submitted to WTC, with few exceptions. The information that WTC
collects will be retained and maintained as required by Texas records retention laws (Section 441.180 et seq. of the Texas Government Code) and
rules.
