Child Support
Paid Verificaon
2019‐2020
Financial Aid Office
541.383.7260 • fax: 541.383.7506
2600 NW College Way, Bend, Oregon 97703
www.cocc.edu/financial‐aid • e‐mail: coccfinaid@cocc.edu
By signing this form, I cerfy the informaon reported is true and accurate. Adobe or signature type fonts will
not be accepted.
Student name printed COCC ID number
Student signature Date Parent signature
(for dependent students only) Date
Name of person that
paid the support.
Name of person that
received the support.
Name of child. Total 2017
amount paid.
$
$
$
$
Age of
child.
Did your parent(s) pay child support in 2017 because of divorce, separaon or a legal requirement for a child not
listed in your household?
Yes No
If yes, please indicate the name of the person who paid the child support, the name of the person to whom child
support was paid, the name of the child and the total amount of support paid in 2017 for that child. Do not in
clude support for children in your household.
Secon B: To Be Completed By Parent(s) of Dependent Student.
Name of person that
paid the support.
Name of person that
received the support.
Name of child. Total 2017
amount paid.
$
$
$
$
Age of
child.
Did you or your spouse pay child support in 2017 because of divorce, separaon or a legal requirement for a child
not listed in your household?
Yes No
If yes, please indicate the name of the person who paid the child support, the name of the person to whom child
support was paid, the name of the child and the amount of support paid in 2017 for that child. Do not include
support for children in your household.
Secon A: To Be Completed By Independent Student.
You or your parent indicated on the 2019‐20 FAFSA® that child support was paid during 2017. COCC is required
to confirm the amount paid. Addionally, COCC may require documentaon of the payments made during 2017.
Complete Secon A for independent students and Secon B for dependent students.
Reviewer use only
Sequence
Date
Inial
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