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This form should be completed by a third party person who can verify that you are separated from your spouse.
This person should be familiar with your current marital situation and should not be related to you.
Student Name: ___________________________________ SSN/ID: ________________________
Name of Third Party Person
Telephone Number
Address
City, State, Zip Code
How do you know the student?
How long have you known the student?
Is the student currently separated form his/her spouse?
When was the approximate date of separation?
Describe what you know about the above student’s current marital status, plans to file for divorce, and
any other relevant information.
Certification Statement
I certify that the above information is true and correct to the best of my knowledge, and I understand
that purposely providing false or misleading information on this form may result in the denial or
repayment of financial aid for the student, in this and/or future years.
Signature of Third Party
Date
2021-2022
Marital Separation Form
Third Party Verification
Office of Financial Aid
1300 S Country Club Road - El Reno, OK 73036
405-422-6250 – Fax: 405-422-1463
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Completed 3 February 2021

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