DIVIND
Divorced/Separated Disclosure - Independent
2019-2020
Office of Financial Aid ▪ 100 East 8
th
Street ▪ PO Box 9000 ▪ Holland, MI 49422-9000
P: 616-395-7765 ▪ F: 616-395-7160 ▪ finaid@hope.edu ▪ hope.edu/financialaid
It is our understanding you were either separated or divorced after filing the 2019-20 FAFSA. To determine
your 2019-20 eligibility for financial assistance, we need further clarification regarding your financial
information.
Complete the following items using only your information, excluding any of your spouse’s information,
even if a joint tax return was filed. If you still jointly own/share any assets, report only your share.
Date of Separation and/or Divorce: ____/____/____
A. Submit a signed copy of your 2017 and 2018 Federal Income Tax Return with W-2 forms.
B. Complete the following information:
1. HOUSEHOLD INFORMATION:
a. Current number in household (excluding your ex-spouse): ______
b. Current number of your household members attending college in 2019-20 ______
c. Amount of child or spousal support you received in 2018
because of divorce or separation $_______
2. UNTAXED INCOME & BENEFITS received during 2018 *
a. Welfare benefits (including TANF). Don’t include food stamps or subsidized housing $_______
b. Social Security benefits received for all household members $_______
c. SSI disability benefits $_______
d. Child support you will receive during the upcoming year for all children
Do not include foster care or adoption payments. $_______
e. Spousal support to be received by custodial parent $_______
f. Worker’s compensation $_______
g. Bills paid for custodial parent by someone else $_______
h. Any other untaxed income or benefits. List source(s): _____________ $_______
*DO NOT INCLUDE THE FOLLOWING UNTAXED INCOME TYPES:
Workforce Investment Act Educational benefits, benefits from flexible spending arrangements
(e.g. cafeteria plans), or combat pay if you are not a tax filer.
3. ASSET INFORMATION: What is it worth today? What is owed on it?
a. Cash, savings, & checking accounts: $__________
b. Investments (excluding retirement plans): $__________ $__________
c. Other real estate (excluding home): $__________ $__________
d. Business: Name _____________________ $__________ $__________
Is the business more than 50% family-owned and controlled?
YES
NO
Does the business have 100 or fewer full-time equivalent employees?
YES
NO
e. Investment farm: $__________ $__________
Do you “materially participate in the farm's operation”?
YES
NO
Student Signature:
_
_ ________________________________
Date Signed:
