2020-2021 Verification of Separated Marital Status
Student Information
Last Name First Name MI
Student ID
( )
--
Date of Birth
Telephone Number E-Mail Address
INSTRUCTIONS: On the 2020-2021 FAFSA, you indicated separated as the marital status for you or your parents.
To document this, complete the information below and attach the requested documentation and return to the
financial aid office as soon as possible. Your financial aid cannot be processed until this information is
received.
Separated Party: Self Parent
Date of Separation: / /
Complete addresses of the two parties who are separated:
Name:
Name:
Address: Address:
City/State/Zip: City/State/Zip:
Phone: Phone:
Please attach one (or more) of the following documents to support your separated status:
• A copy of the separation or divorce decree
• A signed letter from an attorney stating that legal proceedings have begun
• A signed letter from a third party verifying that the parties in question are separated. Acceptable third parties
would include clergy, counselors, friends, relatives, etc. AND documentation of separate households. This
documentation could include copies of rental agreements, utility bills, etc.
By signing this worksheet, I (we) certify that all the information reported on this worksheet is complete and correct. If the student is a
dependent, at least one parent must sign. WARNING: If you purposely give false or misleading information on this worksheet, you
may be fined, be sentenced to jail, or both. WET SIGNATURE REQUIRED (Electronic signatures will not be accepted.)
Student Signature: Date:
Parent Signature: Date:
Forms can be submitted in ONE of the following ways:
Mailing to: Minot State University, Financial Aid Office, 500 University Ave W, Minot, ND 58707
Drop Off on Campus: Minot State Financial Aid Office, 2nd floor, Administration Building
Submitting online via our secure filedrop by visiting: MinotStateU.edu/finaid/verification.shtml
Phone: 800-777-0750 or 701-858-3375 • Fax: 701-858-4310 • For additional questions, email: financialaid@minotstateu.edu
