2020-21 Noncustodial PROFILE
Waiver Request
STUDENT INFORMATION
NONCUSTODIAL PARENT INFORMATION
FREQUENCY OF CONTACT
Name Phone
Permanent Address
street
city state zip
E-mail ________________________________ Employer __________________________________
Status of student’s biological/adoptive parents: Divorced/Separated Never married to each
other
If divorced or separated, indicate year of divorce/separation: _________
Has noncustodial parent ever claimed student as a dependent on a federal tax return? Yes No
If “Yes,” indicate most recent year claimed: _________
Are there any legal orders that limit the noncustodial parent’s contact with the student? Yes No
If Yes, please attach documentation (i.e. restraining order, police report, divorce decree, etc.)
On how many occasions has the student had contact with him/her during the past 12 months? _____
What was the date of the most recent contact? ____________
Please explain the purpose of the contact and whether it was in person, by phone, or other:
_________________________________________________________________________________
Student Name ID or SSN
Permanent Address
street
city state zip
E-mail _______________________________________ Phone
CHILD SUPPORT INFORMATION
REQUIRED DOCUMENTATION
CERTIFICATION
I certify that the information provided on this form is true and complete to the best of my
knowledge.
Student Signature _____________________________________ Date _________________
Custodial Parent Signature ______________________________ Date _________________
Did the noncustodial parent provide child support in 2018? Yes No
If “Yes,” indicate the total amount he/she paid for student: $____________
If there are other children, indicate total paid for all children: $____________
If “No,” indicate the last year that he/she paid any child support: ____________
Personal Statement: Attach a separate page explaining exactly why it is impossible for you to provide
the Noncustodial PROFILE. Include a description of the history and current status of your relationship
with your noncustodial parent, the history and frequency of any contact you have had with that
parent, and a history of any financial support provided for you by that parent. Use multiple sheets of
paper if necessary.
Third Party Support: Attach supporting documentation, such as legal/court documents or a letter
from an attorney, member of the clergy, therapist, teacher, guidance counselor, or other non-family
member who is familiar with your circumstances and in a position to confirm your explanation of the
situation. Be sure that the person writing on your behalf includes his/her name, address, phone
number, and relationship to you (the student).
Waiver requests submitted without supporting documentation and/or third party
corroboration will be reviewed, but are unlikely to be approved.
Office Use Only
Date: Aid Officer Initials:
Approved: Yes No
Comments:
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