Clarificaon of Marital Status
2019‐2020
Studentname(printclearly) COCCIDnumber
Youarereceivingthisformbecausethemaritalstatusyouand/oryourparentsreportedonFAFSA®doesnotmatchwith2017IRS
taxreturnfilingstatus.PleasecompleteandsubmitthisformtotheFinancialAidOffice.COCCmayalsorequireaddionaldocu-
mentaonbasedontheresponsesonthisform.
PleaseexplainwhyyouwereallowedtousethefilingstatuslistedabovegivenyourmaritalstatusontheFAFSA®.Pleaseinclude
dateofmaritalstatuschange,ifapplicable.
Bysigningthisform,Icerfytheinformaonreportedistrueandaccurate.Adobeorsignaturetypefontswillnotbeaccepted.

StudentsignatureDate Parentsignature
(dependentstudentsonly) Date
What was student’s tax filing status according to their 2017 IRS
Tax Return?
Select only one opon.
What was your parent’s tax filing status according to their 2017
IRS Tax Return? Select only one opon.
 Didnotfile2017taxreturn
 Single
 HeadofHousehold
 Marriedfilingjointreturn
 Marriedfilingseparatereturn
 QualifyingWidow(er)
 Donotfile2017taxreturn
 Single
 HeadofHousehold
 Marriedfilingjointreturn
 Marriedfilingseparatereturn
 QualifyingWidow(er)
What was student’s marital status as of the day the FAFSA®
was filed?
Select only one opon.
 Single
 MarriedorRemarried
 Separated
 Divorced
 Widow(er)
Date of married/remarried/divorced/widowed/separated sta‐
tus?
MM/YYYY
Your parent’s (including step‐parent) marital status as of the
day the FAFSA® was filed?
Select only one opon.
 NeverMarried
 Unmarriedandlivingtogether
 MarriedorRemarried
 Separated
 Divorced
 Widow(er)
Date of married/remarried/divorced/widowed/separated sta‐
tus?
MM/YYYY
Student’s Marital Status Parent’s Marital Status (if dependent student)
Financial Aid Office
541.383.7260•fax:541.383.7506
2600NWCollegeWay,Bend,Oregon97703
www.cocc.edu/financial-aid•e-mail:coccfinaid@cocc.edu
Reviewer use only
FAFSA /
Sequence
Date
Initial
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