Non Custodial Parent Form
Student Information
Name
First Name
Last Name
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Non-Custodial Parent Information
Name
First Name
Last Name
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
Employer
Student's biological parents status
Divorced/Separated
Not yet married
Not living together
Other
Please upload a supporting documentation using the file upload tool below
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Letter from your biological parent explaining why you are requesting a waiver of non-custodial parent information. Letter from 3rd party that verifies the contact information of the non-custodial parent. Any other supporting documents
Cancel
of
Do you have insurance? If yes, what type of insurance and coverage that you have.
Do you have other children?
Yes
No
Did you remarried?
Yes
No
Does your non-custodial parent pay for child support?
Yes
No
Other information/Instructions/Comments
Student's Signature
Date Signed
 -
Month
 -
Day
Year
Date
Custodial Parent's Signature
Date Signed
 -
Month
 -
Day
Year
Date
Non-custodial Parent's Signature
Date Signed
 -
Month
 -
Day
Year
Date
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