Submit this completed form and all supporting documents to Lamar State College Port Arthur Financial Aid Office using your preferred method.
Mail: LSCPA Office of Financial Aid ▪ PO Box 310 ▪ Port Arthur, TX 77641 Drop off: 304 Student Center
Scan and email: FinancialAid@lamarpa.edu Fax: 409-984-6021
Revised 10/22/2019
Verification of Separation
Student Information
Name__________________________________________________________________ ID # _________________________
Information
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 Seperation
☐ 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)
N
ame:__________________________________
A
ddress:________________________________
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.
I
f 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).
I
f this is you third year claiming separation you must provide Legal Court Documents Verifying Separation/Divorce (i.e., complaint
for divorce, legal separation, etc.)
Signature and Certification
Each person signing below certifies that all of the information reported is complete and correct.
WARNING: If you purposely give false or misleading information, you may be fined, sent to prison, or both.
__
________________________________________________ __________________________________________________
Student’s Signature Date Parent’s Signature Date
