RETURN THIS ORIGINAL COMPLETED FORM TO:
Wayne Community College - Financial Aid Office - PO Box 8002 - Goldsboro, NC 27533-8002
Faxed or emailed copies will not be accepted (effective 10/7/2020)
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.
NOTA
RY SEAL
My Commission Expires:
________________
2020-2021
Student Marital Status Form
STUDENT NAME: _____________________________________________ WCC ID: _______________________
The Financial Aid Office needs to confirm your marital status as of the date the 2020-2021 FAFSA was completed. This form should
be completed using blue or black ink and be signed in the presence of a notary. PLEASE NOTE – Your eligibility for financial
aid cannot be determined until the verification process is complete.
On the day I signed the 2020-2021 FAFSA, my marital status was:
Married OR Remarried
(2)
Full date of marriage: _____/_____/__________
Month and year of death: _____/_________
Month and year the divorce was finalized: _____/__________
Separated
(3)
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: __________________________________________________________
(M
UST 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
revised 10/7/2020_vlj
