2020-21 Separation of Income
Your FAFSA application was selected by the U.S. Dept. of Education for review in a process called “verification.” In this process we are
required by federal law (34 CFR, Part 668) to compare the information from your FAFSA application with the information provided on
this form. If there are differences between your application information and your verification documents, we may need to correct your
FAFSA information. We cannot process your financial aid until verification has been completed. Please provide the required documents
as soon as possible.
A. Student Information (please print clearly)
Last Name First Name M.I. Student ID Number or Star ID
Email Address Phone Number (include area code)
Address City State Zip Code
B. Separation of Income
Please provide the following documentation:
Date of Separation (mm/dd/yyyy)___________________________
Relationship to Student__________________________________
Complete a Household Size Worksheet
Tax return transcript for 2018: You must request a Tax Return Transcript by following the instructions on the next
page. A Parent Tax Return Transcript is also required for dependent students.
Proof of separate addresses: Acceptable documentation showing current separate addresses (include at least one of
the following for both parties): current paystubs, current utility bills, current bank statements or divorce decree.
Separation of income: Acceptable documentation to revise household income (include at least one of the following
for both parties): wage and income statements or all 2018 W2’s.
C. Signatures
WARNING: If you purposely give false or misleading information, you may be fined, sentenced to prison, or both.
We certify that all of the information reported on this worksheet is complete and correct.
_________________________________________________ ____________________________
Student Signature Date
_________________________________________________ ____________________________
Parent Signature (if Dependent Student) Date
Financial Aid Office
3300 Century Avenue North
White Bear Lake, MN 55110
Phone: 651-779-3305
Fax: 651-779-5816
E-mail: finaid@century.edu
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Obtaining an IRS Tax Return Transcript
Tax filers can request a Tax Return Transcript, free of charge, of their past tax returns. When completing any of
the options listed below, submit your tax return transcript to our Financial Aid Office (contact information on
reverse side). Make sure to include the student’s name and Star ID or Century ID number on the transcript.
Paper Request by Mail:
Go to www.irs.gov/forms-pubs and click on Form 4506-T to download a Request for Transcript of Tax Return
Complete boxes 1-4 on the 4506-T form by filling in your own personal information, and skip line 5a and 5b
Select the boxes next to lines 6 through 8 to request which specific forms you need mailed to you
List the date 12/31/2018 in line 9
Check the box directly above the signature line
Sign the form and list today’s date
Send to the address listed on page 2 of the 4506-T form under Chart for Individual Transcripts. Once you
receive the forms in the mail from the IRS, please bring them into the Financial Aid Office along with your
student ID# or star ID.
In Person Request:
If you require face-to-face service at the Bloomington or St. Paul TAC office, call 844-545-5640 to schedule an appointment.
Street Address
Days/Hours of Service
1550 American Blvd. East
Suite 700
Bloomington, MN 55425
Monday-Friday - 8:30 a.m.- 4:30 p.m.
St. Paul
430 North Wabasha St.
St. Paul, MN 55101
Monday-Friday - 8:30 a.m.- 4:30 p.m.
* Note: If face-to-face assistance is not a priority for you, you may also get help with IRS letters or resolve tax account
issues by phone, toll free at 1-800-829-1040 (individuals) or 1-800-829-4933 (businesses).
For more information on obtaining IRS documentation, please visit: https://www.irs.gov/individuals/tax-return-