Non-Custodial Parent Waiver Request 2022

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Student Information

Student Name

ID or SSN

Permanent Address

Street

City

State

Zip

E-mail

Phone

Noncustodial Parent Information

Name

Phone

Permanent Address

Street

City

State

Zip

E-mail

Employer

Status of student's biological/adoptive parents

Divorced/Separated Never married to each other

If divorced or separated, indicate year of divorce/separation

Has noncustodial parent ever claimed student as a dependent on a federal tax return

Yes No

If 'Yes,' indicate most recent year claimed

Frequency of Contact

Are there any legal orders that limit the noncustodial parent’s contact with the student?

Yes No

If 'Yes,' please attach documentation (i.e. restraining order, police report, divorce decree, etc.)

On how many occasions has the student had contact with him/her during the past 12 months?

What was the date of the most recent contact?

Please explain the purpose of the contact and whether it was in person, by phone, or other

Child Support Information

Did the noncustodial parent provide child support in 2020?

Yes No

If 'Yes,' indicate the total amount he/she paid for student

If there are other children, indicate total paid for all children

If 'No,' indicate the last year that he/she paid any child support

Required Documentation

Personal Statement: Attach a separate page explaining exactly why it is impossible for you to provide the Noncustodial PROFILE. Include a description of the history and current status of your relationship with your noncustodial parent, the history and frequency of any contact you have had with that parent, and a history of any financial support provided for you by that parent. Use multiple sheets of paper if necessary.

Third Party Support: Attach supporting documentation, such as legal/court documents or a letter from an attorney, member of the clergy, therapist, teacher, guidance counselor, or other non-family member who is familiar with your circumstances and in a position to confirm your explanation of the situation. Be sure that the person writing on your behalf includes his/her name, address, phone number, and relationship to you (the student).

Waiver requests submitted without supporting documentation and/or third party corroboration will be reviewed, but are unlikely to be approved. If you are unable to provide third-party documentation and would like to discuss your circumstances, please contact our office.