2019-2020
CHILD SUPPORT PAID
(DEPENDENT)
(FFFA06)
S
TUDENT
I
NFORMATION
__________________________________________________________ ______________________________
_
Last Name First Name M.I.
Student ID#
Your Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. To be
eligible for federal student aid, you must complete the below information and return this form to the Financial Aid Office.
The law says we have the right to ask you for this information before awarding federal student aid. After a comparison of
information on your FAFSA with this worksheet and any other required documents, we will notify you if you need to
make corrections using your Student Aid Report (SAR) or your college may send corrections electronically.
CHILD SUPPORT PAID INFORMATION
List child support paid by your parent(s) from January 1, 2017 through December 31, 2017 Do not include support for
children in the household. In addition to the parent information, if you the student paid child support from January 1,
2017 through December 31, 2017 please include your information below. Our college may request additional supporting
documentation of the payment of child support. If you need more space, attach a separate page.
Name of the Person Who
Paid Child Support
Name of the Person to Whom
Child Support was Paid
2017 Annual Amount
of Child Support Paid
$
$
$
$
$
$
$
Note: The college may request additional supporting documentation such as but not limited to:
• A copy of the separation agreement or divorce decree that shows the amount of child support to be provided; or
• A statement from the individual receiving the child support; certifying the amounts of child support received; or
• Copies of child support payment checks or money order receipts.
CERTIFICATION AND SIGNATURES
Each person signing this form certifies that all the information
reported is complete and correct. The student and at least one
parent must sign and date.
Student: Date:
Parent: Date:
Print Parent Name:
RETURN TO FINANCIAL AID OFFICE:
WARNING: If you purposely give false or
misleading information on this worksheet, you may
be find, sentenced
to jail, or both.
Child for Whom Support was Paid
Name Age
