Divorced/Separated Disclosure - Dependent
Office of Financial Aid ▪ 100 East 8
Street ▪ PO Box 9000 ▪ Holland, MI 49422-9000
P: 616-395-7765 ▪ F: 616-395-7160 ▪ firstname.lastname@example.org ▪ hope.edu/financialaid
It is our understanding that your parents were either separated or divorced after filing the 2020-21 FAFSA. To
determine your 2020-21 eligibility for financial assistance, we need your custodial parent’s financial information.
(Your custodial parent is the parent with whom you lived most in the last 12 months.)
Your custodial parent is to complete the following items using only his/her information, excluding the non-
custodial parent's information (even if a joint tax return was filed). If your parents still jointly own/share any
assets, report only the custodial parent’s share.
Date of Parent's Separation/Divorce:___/___/___ Name of custodial parent: ________________________
A. Submit a signed copy of parent’s 2018 Federal Income Tax Return and copies of W-2 forms.
B. Complete the following information:
1. HOUSEHOLD INFORMATION:
a. Current number in household (excluding the non-custodial parent): _______
b. Current number of custodial parent's household members attending college in 2019-20 _______
(DO NOT INCLUDE CUSTODIAL PARENT)
c. Amount of child or spousal support expected to receive in 2018 by custodial parent
because of divorce or separation $_______
2. UNTAXED INCOME & BENEFITS expected to be received during 2018 *
a. Welfare benefits (including TANF). Don’t include food stamps or subsidized housing $_______
b. Social Security benefits received for all household members $_______
c. SSI disability benefits $_______
d. Child support custodial parent will receive during the upcoming year for all children
Do not include foster care or adoption payments. $_______
e. Spousal support to be received by custodial parent $_______
f. Worker’s compensation $_______
g. Bills paid for custodial parent by someone else $_______
h. Any other untaxed income or benefits. List source(s): _____________ $_______
*DO NOT INCLUDE THE FOLLOWING UNTAXED INCOME TYPES:
Workforce Investment Act Educational benefits, benefits from flexible spending arrangements
(e.g. cafeteria plans), or combat pay if you are not a tax filer.
3. ASSET INFORMATION for Custodial Parent: What is it worth today? What is owed on it?
a. Cash, savings, & checking accounts: $__________
b. Investments (excluding retirement plans): $__________ $__________
c. Other real estate (excluding home): $__________ $__________
d. Business: Name _____________________ $__________ $__________
Is the business more than 50% family-owned and controlled? YES NO
Does the business have 100 or fewer full-time equivalent employees? YES NO
e. Investment farm: $__________ $__________
Does your custodial parent “materially participate in the farm's operation”?
Signature of Custodial