RETURN THIS COMPLETED FORM TO:
Wayne Community College - Financial Aid Office - PO Box 8002 - Goldsboro, NC 27533-8002
FAX: 919-736-9425
Wayne Community College is accredited by the Southern Association of Colleges and Schools Commission on Colleges to award associate degrees. Contact the Commission on Colleges at 1866
Southern Lane, Decatur, Georgia 30033-4097 or call 404-679-4500 for questions about the accreditation of Wayne Community College. The Commission on Colleges may be contacted only if there is
evidence that Wayne Community College is significantly non-compliant with a requirement or standard. Accreditation standards are located at: http://www.sacscoc.org/principles.asp. Inquiries about
Wayne Community College, such as admission requirements, financial aid, educational programs, etc. should be addressed directly to Wayne Community College and not the Commission’s office.
NOTARY SEAL
My Commission Expires:
________________
2019-2020
Student Marital Status Form
STUDENT NAME: _____________________________________________ WCC ID #: _______________________
The Financial Aid Office needs to verify your marital status as of the date the 2019-2020 FAFSA was completed. This form must be
completed in blue or black ink and signed in the presence of a notary. PLEASE NOTE – Your eligibility for financial aid
cannot be determined until the verification process has been completed.
On the day I signed the 2019-2020 FAFSA, my marital status was:
• Full date of marriage: _____/_____/__________
• Month and year of death: _____/_________
• Month and year the divorce was finalized: _____/__________
Separated
• Complete the following statement: I, ________________________________________, am separated from my
PRINT STUDENT NAME
_______________________________________________, since _______/__________. We have been living in
PRINT SPOUSE’S NAME MONTH
YEAR
separate households and have no plans to reconcile.
My spouse’s last known address is:
________________________________________
Street (no PO Boxes)
________________________________________
Street (no PO Boxes)
________________________________________
City, State, ZIP
________________________________________
City, State, ZIP
I understand that my marital status is subject to investigation by the proper authorities. If I purposely provide false or misleading
information in an attempt to receive federal aid, I may be fined up to $20,000, sentenced to prison, or both.
STUDENT SIGNATURE: __________________________________________________________
(MUST BE SIGNED IN THE PRESENCE OF A NOTARY)
OATH OR AFFIRMATION
State of ____________________
County of _________________
Signed and sworn to (or affirmed) before me this day by
(Printed name of signer), _____________________________________.
Date: ____________________
____________________________________ _____________________________
NOTARY SIGNATURE NOTARY’S PRINTED NAME
