19CSMAR 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 Street Address: _____________________________ City, St.: _____________________
Are You Active Military Personnel? YES NO
If yes, where are you stationed? ___________________________________________________
What is your marital status as of today:
Never Married Married Separated
Divorced, now single Widowed
Date you and your spouse were married/remarried? * ___________________________________
Date you and your spouse were separated? * ________________________________________
Date you and your spouse were divorced/widowed? * __________________________________
* You may be required to provide documentation verifying the dates provided. *
Spouse’s / Ex-spouse’s Information:
Full Name: _____________________________________________________________________
Street Address: _________________________________________________________________
City, State: _____________________________________________________________________
Is Spouse/Ex-spouse 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.
By signing this form you are certifying that all the information reported on it is complete and correct.
__________________________________________________________ _________________
Student Signature Date
Student Financial Aid Office
11400 Robinwood Drive
Hagerstown, MD 21742
finaid@hagerstowncc.edu
FAX: 301-791-9165
2019-2020
Marital Status Form –
Student/Spouse
Student Financial Aid Office
11400 Robinwood Drive
Hagerstown, MD 21742
Phone: 240-500-2473
finaid@hagerstowncc.edu
FAX: 301-791-9165
