Non-Custodial Parent Financial Support - 2015-16

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Financial Aid Services
243 Whitmore Administration Building
181 Presidents Drive, Amherst, MA 01003
Phone: 413-545-0801
Fax: 413-545-1700
Web: umass.edu/umfa
Email: fi naid@fi naid.umass.edu
2015-2016 NON-CUSTODIAL PARENT FINANCIAL SUPPORT
Student Name:_______________________________________________________ SPIRE ID:______________________
Non-Custodial Parent Name:____________________________________________ Phone Number: (
) _____- _______
Non-Custodial Parent Home Address: ____________________________________________________________________
The non-custodial parent must complete, sign, and return this form to Financial Aid Services.
In order to continue review of the fi nancial aid application for the student listed above, you must provide the
information requested below. List the amounts you paid to, or on behalf of, this student during 2014:
Amount $
Tuition/Fees/Room/Board Payment
$_________________
(to school, or tuition savings plan, payment plan)
Other education related payments (books, supplies, misc.)
$_________________
Cash given to student
$_________________
Laptop, tablet, or other electronic gift
$_________________
Cell Phone Payment
$_________________
Clothing
$_________________
Food or Enterntainment
$_________________
Transportation Expenses (bus, plane, train fares)
$_________________
Car Payment
$_________________
Car Insurance Payment
$_________________
Car related expenses (repairs, gas, registration, inspection)
$_________________
Medical/Dental Care/Insurance Payment
$_________________
Vacation or Travel Expenses (ticket, lodging, incidentals)
$_________________
Credit Cards, Fines, Membership Payments
$_________________
Other fi nancial support paid on behalf of, or to the student
$_________________
I certify that the information provided is true and accurate. If I purposely give false or misleading information to Financial Aid Services,
I may be fi ned, sentenced to prison, or both.
Please be aware Financial Aid Services is obligated
to report fi nancial aid applicants that purposely
_________________________________________________________
misreported information or altered documentation to
Non-Custodial Parent Signature
Date
obtain federal funds to the Offi ce of Inpector General
for investigation and prosecution.
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)

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