Marital Separation Form

College Connect Locations
SUNO Campus: Miguel Devezin
Bashful Administration Bldg, Rm 210
Phone: 504-286-5007
Fax: 504-286-5213
Email: [email protected]
SUBR Campus: Carey Williams
Stewart Hall, Rm 107
Phone: 225-771-5630
Fax: 225-771-4954
Email: [email protected]
Office of Student Financial Aid & Scholarships
L.C. Barnes Administration Bldg, Rm A-43
3050 Martin Luther King, Jr. Drive Shreveport, La 71107
Phone: (318) 670-9221 Fax: (318) 670-6313 Email: [email protected]
VERIFICATION OF MARITAL SEPARATION
9000
Name: ____________________________ Student ID: __________________
Email address: _________________________________________________
On your application for the Free Application for Federal Student Aid you indicated your marital
status was “separated”. In order for us to complete your file, you must provide documentation
verifying that you are separated for the purpose of divorce and that you are not receiving support
from your spouse (other than child support or alimony). Please provide the document(s)
indicated below:
1. A notarized letter from you verifying the date of separation and explanation of
financial support expected.
2. A copy of any pre-divorce documents from your attorney or the court, OR a
letter from a social agency, such as the Department of Human Services, stating
they are aware of your separation, and according to their files, you are considered
separated for their programs.
3. A copy of your housing contract showing that you are maintaining a separate
household.
4. A copy of your spouse’s housing contract.
5. A copy of your tax return. If filed a joint tax return an explanation from
you and your tax accountant of why you continue to file a joint return will be
required.
Southern University at Shreveport does not discriminate on the basis of race, color, national origin, gender, age or disability. Title IX Coordinator: Ms. Tilisha T.
Bryant, Administration Building, Room A-43, (318) 670-9210. Section 504 Coordinator: Ms. Jerushka Ellis, Fine Arts Building, Room C04 D, (318) 670-9473.
Revised 03/2016