Financial Aid & Scholarships 2015-16 V4 Verification Form (Page 3 of 3) in pdf

Financial Aid & Scholarships 2015-16 V4 Verification Form Page 3

Arkansas State University-Newport

Financial Aid & Scholarships

2015-16 Child Support Verification Form

__________________________________________________________________

If you reported on the FAFSA that you paid child support you MUST complete and submit this form to the

Financial Aid Office.

If you did not report child support paid on the FAFSA, you do not need to complete this form.

To verify correct information was provided, the financial aid office must compare the FAFSA information submitted by the student with the

information on this worksheet and other required documents. If there are differences, the FAFSA information may need to be corrected. The

school may ask for additional information.

Student Name (Last name, first name)

ASUN ID number

Cell phone number

List the amount of PAID court mandated child support in 2014.



No child support was paid.

Name of Person Who

Name of Person to Whom

Name of Child for Whom

Amount of Child Support

Paid Child Support

Child Support was Paid

Support was Paid

Paid in 2014

Mary Jones (example)

Chris Smith (example)

Terry Jones

$6,000.00

By signing this Verification Statement, I (we) certify that all information reported is complete and accurate. WARNING: If you

purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.

Student Signature

Date

Student’s Spouse or Parent Signature

Date

Financial Aid & Scholarships 2015-16 V4 Verification Form Page 3