Revised 02/27/2019
Office of Student Financial Aid – Lamar State College Port Arthur
MEMBER THE TEXAS STATE UNIVERSITY SYSTEM
TM
Verification of Separation 2019-2020
Name_______________________________________________________ Student ID #____________________
Marital separation is defined as: (a) One of the partners has left the household for an indefinite period; and (b) the
marriage is severed. If your circumstance does not meet this definition, then you (or your parent, if a dependent) are
required to submit spouses’ information. Note: you must meet both parts of the definition to be considered separated.
STEP ONE
Please indicate your proof of separation:
☐ Legal Court Documents Verifying Separation/Divorce (i.e., complaint for divorce, legal separation, etc.)
OR
☐ Certification and Statement of Marital Separation: Continue onto Step two
STEP TWO: Certification and Statement of Marital Separation
I, _______________________________, do hereby certify that my current marital status is separated from my spouse.
I certify that we are and have continued living separated and the marriage is severed. Currently, my separated spouse
resides at:
SEPARATED SPOUSE INFORMATION (Please Print)
Name:__________________________________
Address:________________________________
City, State, Zip:___________________________
Date of Marriage: Date of Separation: _______________________________
MM/ DD/ YYYY MM/ DD/ YYYY
Divorce Intentions: Do you intend to proceed with the divorce? ____ Yes ____ No
STEP THREE: Supporting Documentation
Provide Legal Court Documents Verifying Separation/Divorce (i.e., complaint for divorce, legal separation, etc.) OR
2 notarized statements (enclosed) from non-family members (clergy member, lawyer, landlord, counselor, etc.)
which confirms your separation claim.
If this is your second year claiming separation, also provide proof of separate living arrangements (copies of
documents which are in your name only such as utility bills, lease/rental/mortgage documents).
If this is you third year claiming separation you must provide Legal Court Documents Verifying
Separation/Divorce
(i.e., complaint for divorce, legal separation, etc.)
Certification and Signatures
I hereby certify that all information contained in this form is true and complete to the best of my knowledge.
_________________________________________ ______________________________________
Student’s Signature Date Parent’s Signature Date
