Separation Worksheet
2016-2017
Student Financial Services – K 1.700
3201 W. Pecan Blvd. McAllen, TX 78501
Phone (956) 872-8375 Fax (956) 872-6461
STC ID:________________________________ Name:____________________________________
SSN: __________________________________ Phone Number:____________________________
A financial aid applicant who believes he/she made a mistake on the Free Application for Federal Student Aid
(FAFSA) when reporting his/her marital status (for Independent Student) or when reporting parents’ marital
status (for Dependent Student) but who is in fact separated as of the date he/she first applied for financial aid
for this award year, should read and complete this form. The description below is published by Department of
Education:
“A couple need not be legally separated to be considered separated – they may deem themselves informally
separated when one of the partners has left the household for an indefinite period and the marriage is severed.”
(2016-2017 U.S. Department of Education SFA Handbook Chapter 2 Page AVG – 29)
Dependent Student – Provide information below for the parent whose information you DID NOT use to complete
your FAFSA.
Independent Student – Provide information below for your separated spouse.
Parent/Spouse’s name: __________________________________Phone number:___________________________
Parent/Spouse’s address:________________________________________________________________________
Date of Marriage (MM/DD/YY): ____/____/____ Date of Separation: (MM/DD/YY) ____/____/_____
Federal Tax Information: When was the time a joint tax return was filed?
Check one:
Tax year 2015
Tax year 2014
Never Filed Joint
Other Year (Specify)______
Dependent Student - Did your parent (the one you whose information you used to complete your FAFSA) receive
any other income (i.e. Cash, Social Security, Supplemental Income, Retirement pensions, VA Benefits, Alimony,
Child Support, Workers Compensation, TANF or Other)?
Independent Student - Did you receive any other income (i.e. Cash, Social Security, Supplemental Income,
Retirement pensions, VA Benefits, Alimony, Child Support, Workers Compensation, TANF or Other)?
Yes
No
If yes, please list them below: Please provide supporting documentation.
You MUST provide this office with a copy of your legal separation/divorce decree or you MUST provide a letter on
business letterhead from one of the persons listed below stating your situation.
A notarized statement on your behalf is not acceptable. If you do not provide the necessary documentation you
will be required to submit your parents’/spouse’s information.
Your pastor
Your marriage counselor
Your attorney
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STC ID:________________________________ Name:____________________________________
Processing your Separation Worksheet may take up to 2 weeks from the time it is submitted
or longer during peak registration time. Incomplete documentation will delay the review
process. Any tuition and fees you owe the college are due on the date specified regardless of
the status of your Separation Worksheet. Payment arrangements should be made while your
Separation Worksheet is reviewed.
You acknowledge that it is your responsibility to check on the status of this Separation
Worksheet through your Jagnet account, by clicking on the Student Services link, then
the Financial Aid link, then the Financial Aid Status link, select appropriate award year,
then click on “You have active messages”. Your signature on this document binds you to
all conditions stated within.
Student Signature: ___________________________________________ Date: __________________
Parent Signature: ____________________________________________ Date: __________________
Student Financial Services Department Use Only
Approved ___ Disapproved ___ Pending ___ FACM Initials: ____________________ Date: _____________________
Additional Information Requested/Comments: ______________________________________________________________
No person shall be excluded from the participation in, denied the benefits of, or be subject to discrimination
under any program or activity sponsored or conducted by South Texas College on the basis of race, color,
national origin, religion, sex, age, veteran status or disability.
Revised 4-21-16 FAC
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