Newark, DE 19716-6740
Phone: 302-831-2126
Fax: 302-831-3041
Student Financial Services
2020-2021 Academic Year
Parental Certification of Refusal to Provide INformation
Parent: Complete the Information sections and read each statement in the Statement section. Enter the
student’s name and the date you stopped supporting the student. Upon receipt of the completed form,
the dependent student may be granted an Unsubsidized Federal Stafford Loan, at the discretion of
Student Financial Services.
Certification: The parent MUST sign the completed form in the Certification section. By signing, the parent
certifies agreement with each of the statements in the Statement section.
Please submit this document via My SFS Docs:
Student Information
Last Name First Name Middle Initial
UDID Phone UD Email
Parent Information
Last Name First Name Middle Initial
Phone Email
Read statements 1-4. Enter the date in statement 3 in which you stopped supporting the student. Incomplete forms will be
returned without being processed.
1. I understand that the dependent student will only be eligible for an Unsubsidized Stafford Loan and will not be
considered for any other forms of federal, state, or institutional financial aid. I understand that the student will not
be considered independent for financial aid purposes.
2. I, the parent of , refuse to complete the parental section of the Free Application for
Federal Student Aid (FAFSA).
3. I, the parent of , have stopped providing financial support to the above student. I
understand that financial support includes payment of educational costs, cash and non-cash support, and providing
room and board for the student.
The date on which I stopped supporting the student is (required).
4. I, the parent of , will not provide any financial support in the future.
I certify that the above information is true and complete. I acknowledge and understand each of the statements
in the Statement section of this form. By signing below, I further certify that I agree with each of the statements
in the Statement section.
Parent Signature
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