Fillable Verification Of Snap And Child Support Paid Dependent printable pdf download

VERIFICATION OF SNAP CHILD SUPPORT PAID

Financial Aid Services

DEPENDENT (V4)

2016-2017

PART I: STUDENT INFORMATION

Name: __________________________________________________________________

SPIRE ID: _____________________________

Last

First

Middle

Date of Birth: _____/_____/_______ Phone Number: (

) ______-________ Email Address:_____________________________________________

Please note: That in addition to this completed form, you are required to present Proof of Identity, sign a Statement of Educational Purpose and

submit proof of High School Completion. Stop by Financial Aid Services with a valid Government issued ID and a copy of your High School Diploma

or equivalent document to meet these requirements.

If clariﬁ cation of your situation is necessary, additional information or documentation may be required. Check your SPIRE To Dos.

Contact Financial Aid Services at 413-545-0801 if you have any questions.

PART II: SNAP BENEFITS

Did your parents or any one in their household received Food Stamps (SNAP- Supplemental Nutrition Assistance Program) in 2015?

Yes

PART III: CHILD SUPPORT PAID

A. Complete this section if your parent or stepparent PAID child support to another household in 2015.

Do not include child support paid for people living in your parent’s Household.

Name of Person Who Paid Child Support

Name of Person to Whom Child Support was Paid

Name of Child for Whom Support Was Paid

of Child

Amount Paid in 2015

Age

Note:

If we have reason to believe the information regarding child support paid is not accurate, additional documentation may be required, such as: a copy of court document 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, copies of the child

support payment checks or money order receipts, or documentation from State or Federal Office of Child Support Enforcement.

Any ﬁ nancial aid awarded prior to veriﬁ cation is tentative. Financial Aid Services has the right, after reviewing your veriﬁ cation

information, to change or cancel your award.

Changes in funding, administrative/technical errors, changes in application information,

enrollment status or reclassiﬁ cation in residency will aﬀ ect your ﬁ nancial aid award and may result in a revised ﬁ nancial aid award.

PART IV: CERTIFICATION

By my signature, I certify that all information submitted with, and written on this application, is complete, accurate, and corrections may

be made based on data provided, and that if I purposely give false or misleading information on this worksheet, I may be ﬁ ned, sentenced

to prison, or both. I also certify that any federal or state ﬁ nancial aid funds I may receive will only be used to pay for educational expenses

related to my attendance at the University of Massachusetts Amherst for 2016-2017.

Please be aware Financial Aid Services is obligated to report ﬁ nancial aid applicants that purposely misreported information or altered documentation to obtain

federal funds to the Oﬃ ce of Inspector General for investigation and prosecution.

Parent Signature: __________________________________________ Student Signature: ___________________________________ Date: ____________

Document must be signed with a real signature. Digital signatures are not accepted.

Fax completed, signed form to: 413-545-1700

or email completed, signed form to: fadocs@ﬁ naid.umass.edu

(Attachments must be a standard image ﬁ le, or in one of the following ﬁ le formats: .doc, .docx, .pdf)

*FV4DO*