203 Day Hall

Ithaca, New York 14853-2801

t. 607.255.5145
f. 607.255.6329
finaid@cornell.edu
http://finaid.cornell.edu

Divorce/Separation Form for Students

This form should only be completed by students who have indicated they are divorced or separated.

Student:_________________________________________ Date of Birth:_________________________

Last Name First Name

Cornell University requires students who report their marital status as separated or divorced to document that
status. Attach all supporting documents to this form and submit together.

1. Please provide the following information about your spouse/former spouse:

Name:

Current address:

2. Date of Marriage: Date of Separation/Divorce:

3. Federal Tax Information: When was the last time a joint tax return was filed?

4. Documentation:

a. If divorced, provide a copy of the divorce decree.

b. If separated and pursuing a divorce, provide copies of the court documentation.
c. If separated but not currently pursuing a divorce, provide a copy of the separation agreement.
d. If separated but not currently pursuing a divorce, and a copy of the separation agreement is not
available, please provide copies of documents which are in your name only such as utility bills,
lease/rental/mortgage documents, and bank statements.
e. Additional documentation may be requested by the Office of Financial Aid and Student
Employment.

By signing this form I agree that the information provided is true, correct, and complete. I further agree to
provide, if requested, any other official documentation necessary to verify the information reported.

Student Signature __________________________________________________ Date ____________