Student Name: _____________________________________________________________________________________
Student ID: _________________________________ OR Social Security Number: X X X – X X – ___ ___ ___ ___
Use this form to report the divorce or separation of the parents of a dependent student after the FAFSA has been filed.
1. Date of divorce finalization/separation (mmddccyy): _______________________________
2. Name of parent remaining in the household: __________________________________________________
3. Indicate related change to household size. The household size was ____ and now is ____.
4. Complete the chart below. Indicate the actual and/or anticipated monthly gross income of the parent with whom the
student is predominantly living or who will provide more than half of the student's support. Also include the monthly
actual and/or anticipated child support funds paid ____ or received ____ (check one, if applicable).
EACH FIELD MUST CONTAIN A NUMERIC VALUE. ENTER $0, IF APPLICABLE.
July August September October November December
2017 2017 2017 2017 2017 2017
January February March April May June
2018 2018 2018 2018 2018 2018
5. Attach required documentation:
a. Document(s) that support the divorce or separation
has occurred
b. Parents’ 2015 Federal Income Tax Return
c. 2015 W2 form(s) for the parent remaining in the household
d. Child support/alimony payment documents
Validation Statement: I certify the information provided is complete and true to the best of my knowledge. Furthermore,
I agree to contact the Financial Aid Office at the time there are changes to the situation on which the request for exception
has been founded. I understand that changes made to my student financial aid eligibility based upon the information
provided may affect only the student financial aid received at Indiana Wesleyan University for the 2017-2018 award year.
_________________________________________________________________________ ______________________
Student Signature Date
_
________________________________________________________________________ ______________________
Parent Signature Date
Mail, email, or fax completed form and supporting documentation to:
Financial Aid Office, IWU-National & Global 1900 West 50
th
Street Marion, IN 46953-9393 indwes.edu
800.621.8667 option 4 765.677.2516 765.677.2030 Fax IWUfinaid@indwes.edu
NOTE: If you are receiving a set amount of income or
child support (or paying child support) on a weekly
basis for the entire duration of July 2017 through June
2018, please keep in mind that there are on average
more than 4 weeks per month. To correctly calculate
monthly amounts, you must multiply the weekly
amount by 4.3333 (weeks).
DIVORCE OR SEPARATION
FINANCIAL AID OFFICE
