19CPMAR 1/11/2019
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.
Student Name _____________________________________ HCC ID: ________________________
Student Address: ____________________________________ City, St.: _______________________
What is your parents (or parent/step-parent) marital status as of today (check only one and fill out only one
date below)?
Never Married Unmarried, both parents living together Separated
Married, or remarried Divorced, now single Widowed
Date your parents (or parent/step-parent) were married/remarried? * ____________________________
Date your parents (or parent/step-parent) were separated?
* ____________________________
Date your parents (or parent/step-parent) were divorced/widowed?
* ____________________________
* You may be required to provide documentation verifying the dates provided. *
Mother/Father/Step-Parent Information: Full Name: ___________________________ Date of Birth: _____
Street Address: __________________ City, St: _____________________________________________
Is this person Active Military Personnel? YES NO
If yes, where is this person stationed? ________________________________________________
Mother/Father/Step-Parent Information: Full Name: ___________________________ Date of Birth: _____
Street Address: ________________________________ City, St: _______________________________
Is this person Active Military Personnel? YES NO
If yes, where is this person stationed? _________________________________________________
IMPORTANT: If you would like to provide a statement to help explain the marital status circumstances,
please feel free to do so.
Each person signing this form certifies that all the information reported on it is complete and correct.
________________________________________________________ ____________________
Student Signature Date
________________________________________________________ ____________________
Parent Signature Date
Student Financial Aid Office
11400 Robinwood Drive
Hagerstown, MD 21742
finaid@hagerstowncc.edu
FAX: 301-791-9165
2019-2020
Marital Status Form –
Parent(s)
Student Financial Aid Office
11400 Robinwood Drive
Hagerstown, MD 21742
Phone: 240-500-2473
finaid@hagerstowncc.edu
FAX: 301-791-9165
