WARNING: If you purposely give false or misleading information, you may be fined, sent to prison or both.
OFFICE OF STUDENT FINANCIAL AID
ROBESON COMMUNITY COLLEGE
Student Center Building 13
PO Box 1420
Lumberton, NC 28359
T 910.272.3352 Email: finaid@robeson.edu
F 910.272.3314 Website: https://www.robeson.edu/fa/
2020-2021 Verification of
Separation Status
Student’s Name: ____________________________________StudentID____________________
Address: _______________________________________City/State/Zip____________________
Phone #: _______________________________Email: ________________________________
This document needs to be completed by: ☐Separated Student ☐ Separated Parent
You must sign this form in the presence of a notary. The Financial Aid Staff may not provide notarization.
I, (print your full name) ______________________________________________, am separated from my spouse,
(print spouse’s full name) , as of .
We are no longer residing together and plan to obtain a divorce.
My address is: Street Apt _______________
City State Zip _______________
My spouse’s address is: Street Apt _______________
City State Zip _______________
☐ Check box if spouse’s address is unknown. If box is checked, please provide a typed letter detailing the
situation of why the spouse’s address is unknown.
NOTE: You must submit a letter on letterhead from one of the following persons or organizations:
For military and their dependents: A letter is required from the Family Services Office, the Unit
Chaplain, or the Unit S-1 Personnel Office.
For civilians: A Letter is required from a clergyperson, an attorney, or your employer.
Separated Person's Signature _______________________________ Date: ___________________
click to sign
signature
click to edit
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