Statement of Child Support Paid by
Office of Financial Aid ▪ 100 East 8
Street ▪ PO Box 9000 ▪ Holland, MI 49422-9000
P: 616-395-7765 ▪ F: 616-395-7160 ▪ email@example.com ▪ hope.edu/financialaid
Report the total amount of child support your parent or stepparent paid in 2018.
Do NOT include amounts paid for children reported in your parent’s household on
Name of person who paid child support: _________________________________
Name of person to whom child support was paid: ______________________________
Home address of recipient: _______________________________________
WARNING: If you purposely give false or misleading information, you may be fined, sent
to prison, or both.
My signature below certifies that all of the information reported is complete and correct.
NAME & AGE of CHILD
for whom child support was paid
AMOUNT PAID IN
FOR CHILD SUPPORT
Parent Who Paid
Child Support to