Legal Name
Student EID
Parent Signature
Date
Service EMU Locations: 240 McKenny Hall &
268 Student Center
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Fax: 734.487.4281
Email: financial_aid@emich.edu
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Web: www.emich.edu/finaid
2019-2020 SAR Comment Code 361-364
PCC
Our office has received your 2019-2020 Free Application for Federal Student Aid (FAFSA). Your
FAFSA indicates that your parent may have reported conflicting information regarding their
marital and tax filing status on your FAFSA. In order to resolve any potential conflict, please
complete and return this form to our office as soon as possible.
Please respond to the questions below that apply to your parent whose information was reported
on your FAFSA:
1. Parent name _______________________________________
2. Parent's marital status at the time the 2019-20 FAFSA was filed (Choose one):
separated divorced married/remarried other
3. If marital status is "separated or divorced," please provide date: ________________(mm/dd/yyyy)
4. If marital status is "married or remarried," please provide date:__________________(mm/dd/yyyy) and
spouse name _________________________________
5. If marital status is "other," please explain:_________________________________________________
________________________________________________________________________________
Please submit a signed copy of your parents’ 2017 IRS tax return transcript with this form. If your
parent is married/remarried but filed separate tax returns from his/her spouse, you must submit
signed copies of both parent and spouse’s tax returns.
By signing this worksheet, I certify that this information reported is complete and correct. I
further understand that purposely giving false or misleading information regarding eligibility for
Federal or State aid may result in fines, jail terms or both.
