2019-2020 Noncustodial Profile Waiver Request

This form should be used by aid applicants who are requesting the waiver of noncustodial parent data. Information about George Washington University’s Parental Contribution for Dependent Students Policy is available on our website (https://financialaid.gwu.edu/policies).

Attach to this form a letter to explain why you are unable to provide noncustodial information. The letter should be as specific as possible and include a description of the history and current status of your relationship with and financial support provided by your noncustodial parent. Include any supporting documentation, such as legal/court documents, letter from an attorney, member of the clergy, therapist, teacher, guidance counselor, or other non- family member who is familiar with your circumstances. Any letters submitted on your behalf should include the person’s 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 tend to be less compelling and thus are less likely to be approved.

GW Student Last Name First Name MI GWid

REASON FOR WAIVER REQUEST Location of noncustodial parent is unknown – letter from custodial parent and supporting documentation Legal orders limiting contact with noncustodial parent – copy of legal order Noncustodial parent is deceased – copy of death certificate Other (please specify in a separate letter) – supporting documentation as appropriate

PARENT INFORMATION

Custodial Parent Name Address Email Address

Noncustodial Parent Name Address Email Address

Check all that apply and provide requested information

Parents are Divorced / Separated Year of divorce/separation Parents were never married and are not sharing a household

Noncustodial parent has or will claim the student as a dependent on federal tax returns. Most recent year claimed 2018 Noncustodial parent child support paid For the student For all children No support paid in 2018 For the student Last year support received

CERTIFICATION We certify that the above is complete and accurate to the best of our knowledge.

Student Signature Date

Custodial Parent Signature Date

Documents may be submitted by fax 202-994-0906, email [email protected] or mail 800 21st Street NW, Washington, DC 20052 NCPWR_1920 More information about financial assistance at GW may be found on our website financialaid.gwu.edu 10/2018