2014–2015
Verification of Child Support
A. Student’s Information
________________________________ _____________________________________ ___________________
Student’s Last Name Student’s First Name Student #
____________________________________________ _________________________________________
Student’s Email Address Student’s Phone Number (include area code)
B. Verification of Child Support
Check the box below and complete the section below if you or one (or both) of your parents paid
child support in 2013.
I or one (or both) of my parents listed in Section B of this worksheet paid child support in 2013. I have indicated
below the name of the person who paid the child support, the name of the person to whom the child support
was paid, the names of the children for whom child support was paid, and the total annual amount of child
support that was paid in 2013 for each child. If asked by the school, I will provide documentation of the payment
of child support. If you need more space, attach a separate page that includes the student’s name and Social
Security Number at the top.
Name of Person Who Paid
Child Support
Name of Person to Whom
Child Support was Paid
Name of Child for Whom
Support Was Paid
Amount of Child
Support Paid in 2013
Marty Jones Chris Smith (example) Terry Jones $6,000.00
Note: If we have reason to believe that the information regarding child support paid is not accurate, we may require
additional documentation, such as:
A copy of the separation agreement or divorce decree that shows the amount of child support to be
provided;
A statement from the individual receiving the child support certifying the amount of child support received;
or
Copies of the child support payment checks or money order receipts.
C. Certification and Signatures
Each person signing this worksheet certifies that all of the information reported is complete and
correct. The student and one parent (if dependent) must sign and date.
_________________________________________________ _________________________________
Student’s Signature Date
_________________________________________________ _________________________________
Parent’s Signature (Required for dependent students) Date
Your 2014–2015 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. We 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 and at least
one parent must complete and sign this worksheet if dependent, attach any required documents, and submit this form and other required documents to the
inancial Aid O
ice.
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.
