INCSP 1314 INDEPENDENT CHILD SUPPORT VERIFICATION FORM (V3)
Your 2013 -2014 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called Verification. The law says before awarding Federal
Student Aid, we may ask you to confirm the information you reported on your FAFSA. To verify that you provided correct information the financial aid administrator at your
school will compare your FAFSA with the information on this worksheet and with any other required documents. If there are differences, your FAFSA information may
need to be corrected. You must complete and sign this worksheet, attach any required documents, and submit the form and other required documents to the financial aid
administrator at your school. Your school may ask for additional information. If you have questions about verification, contact your financial aid administrator as soon as
possible so your financial aid will not be delayed.
A. STUDENT INFORMATION
ID # (MUST start with A)
First Name MI Last Name
Phone (Format: XXXXXXXXXX) E-mail
SSN (Format: XXXXXXXXX)
Date of Birth
B. INDEPENDENT STUDENT'SCHILD SUPPORT PAID INFORMATION TO BE VERIFIED
C. CERTIFICATIONS AND SIGNATURES
Electronic Signature Agreement. By providing your full student ID # below and by selecting the "I Accept" button, you are signing this Agreement
electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this Verification Form. By selecting "I
Accept" you consent that all of the information reported is complete and correct. You further agree that your use of a key pad, mouse or other
device to select an item, button, icon or similar act/action, constitutes your signature (hereafter referred to as "E-Signature"), acceptance and
agreement as if actually signed by you in writing.
WARNING: If you purposely give false or misleading
information on the worksheet, you may be fined, be sentenced to jail, or both.
To electronically submit this form you MUST use the "SUBMIT" button located at the top of this form.
You MUST have Adobe Reader 9 or higher to submit this form electronically.
If you DO NOT see a submit button in the top right of this form you will need to
To verify your form was properly submitted, allow 48 hours then check your "Financial Aid Status" in your Banner Self Service account.
I Accept
ID #
(MUST start with A) Enter Full Name
Did you or your spouse, if married, pay child support in 2012?
See drop down menu for options.
If yes, I certify that I paid child support in 2012. I have listed below the names of the persons to whom the child support was paid, the names of the
children for whom the child support was paid and the total amount of child support paid in 2012 for each child. I also attest that I have not included these
children as members of my household size. (Parents can either include these children as members of the household *or* include the amount of child
support paid but may not include these children as members of the household and also list child support paid.
Name who paid the child support Name who received the support For whom support was paid Yearly amount paid
Office Use Only
Submitted Notified
Initials:
CSP
