Louisiana Separation Agreement Template
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Southeastern Louisiana University
Certification of Separation or Divorce

Office of Financial Aid
SLU 10768
Hammond, LA 70402

Student's Name:

Phone: 985-549-2244
Fax: 985-549-5077

University ID: W

INSTRUCTIONS TO STUDENTS and/or PARENTS: You are completing this form to verify your
separation or divorce from your spouse. You are certifying this information to be true and correct. Please
read statement below prior to signing.

, certify that I am


from my spouse

(Spouse's name)

I reside at

(Separated or divorced)

as of

(Month, Day, and Year)


(Physical Address- No P.O. Box)


Please read, sign and date.
If you are the parent or the student, by signing this form you agree, if asked, to provide information that will verify the
accuracy of this completed form. This information may include your U.S. or state income tax forms, divorce decree,
utility bills, etc. Also, you certify that you understand that the Secretary of Education has the authorit