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
3300 Century Avenue North
White Bear Lake, MN 55110
Phone: 651-779-3305
Fax: 651-779-5816
E-mail: finaid@century.edu
A MEMBER OF THE MINNESOTA STATE COLLEGES & UNIVERSITY SYSTEM
AN AFFIRMATIVE ACTION EQUAL OPPORTUNITY EMPLOYER & EDUCATOR
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