Fillable 202223 Academic Year Noncustodial Parent Waiver Request (Princeton University)

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202223 Academic Year Noncustodial Parent Waiver Request (Princeton University)

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Non‐custodial Parent Waiver Request
2022–23 Academic Year
Undergraduate Financial Aid
Box 591, 330 Alexander St.
Princeton, NJ 08542‐0591
T 609.258.3330
F 609.258.0336
E faoffice@princeton.edu
finaid.princeton.edu
Student Information
Name: ____________________________________________________________________ DOB: ________________
Application ID Number: ______________________________________________________
Instructions: It is Princeton’s policy to require information from both parents in order to determine eligibility for financial
aid. By completing this form, you are requesting that your non‐custodial parent’s information be excluded from the
financial aid process. Before we can make this decision, we need the following information. You must provide all
information requested below.
1.
Parents’ Current Marital Status ☐ Div
orced ☐ Separated ☐ Never Married
If divorced or separated, year of divorce or separation: _____________________________________________
2.
Statements from Student and
Custodial Parent
Both you and your custodial parent must submit personal statements to help us better understand the
circumstances surrounding the non‐custodial parent. Any supporting documentation (e.g. legal order, police report)
you feel is relevant should accompany the statements.
3.
Third‐party Statements
Attach two statements from
third parties who can verify the circumstances regarding your relationship with your
non‐custodial parent. The statements should be on professional letterhead and include the party’s name, contact
number, the number of years they have known you, and their relationship to you. The statements must be from
individuals familiar with your situation in a professional capacity such as a counselor, clergy, teacher, or lawyer. The
statements may not be from family members or friends.
4. Non‐custodial Parent Contact Information
Name: ________________________________________________________________________________________
Address: ______________________________________________________________________________________
Email: _________________________________________________ Phone: _______________________________
5.
Approximate numb
er of times the non‐custodial parent and student had contact with one another during the last
twelve months? ___________________________
What was the nat
ure of the contact? ☐ Email ☐ Phone ☐ In person
If no contact in the last twelve months, when was the last point of contact? ____________________________
6.
Has your non‐cus
todial parent ever claimed you as a dependent on a federal tax return? ☐Yes ☐No
If yes, what is the
most recent year? ____________________________________________________________
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7. Did your non‐custodial parent pay child support in 2020?
☐ Yes ☐ No
If yes, indicate total amount paid for you
and sibling(s): $___________________________________________
Please indicate if the child support was: ☐ Voluntary ☐ Court‐ordered ☐ Garnished Wages
8. Has your non‐custodial parent paid child support in 2021?
☐ Yes ☐ No
If yes, indicate total amount paid for
you and sibling(s): $___________________________________________
For how many months? ______________________________________________________________
If no, indicate last year child support was paid: ___________________________________________________
9.
Has your non‐custodi
al parent provided financial support, ot
her than court‐ordered child support, in the last twelve
months (such as private school, medical or dental bills)? ☐ Yes ☐ No
If yes, indicate the total amount of support provided:
$ ____________________________________________
10.
Are you covered under any insurance plans
(e.g. health insurance) by your non‐custodial parent? ☐ Yes ☐ No
If yes, what type of insurance? ________________________________________________________________
11.
Are there any legal orders limiting your non‐custodial parent’s contact with you? ☐ Yes ☐ No
If yes, please explain and attach documentation to this form.
Certification
All members of the University community are expected to be honest and straightforward in their official dealings with
University processes, activities, and personnel. This obligation includes honoring contracts and agreements and providing
accurate information on official forms and documents as well as to official University personnel, offices, and committees.
Deliberate violations of this provision will be considered serious offenses; subsequent violations, or systematic violations
in the first instance, will be considered extremely serious. (1.1.5 Honesty and Cooperation in University Matters, Rights,
Rules, Responsibilities, 2021
edition)
I certify that the information contained within this document and all enclosures is complete and accurate. I understand
that misrepresentation or falsification on this and any financial aid document will result in penalties to be determined by
Princeton University.
Custodial Parent Signature: _______________________________________________ Date: ____________________
Student signature: ______________________________________________________ Date: ____________________
Rev. Sept. 13, 21
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202223 Academic Year Noncustodial Parent Waiver Request (Princeton University)

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Completed 22 January 2022

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