Child Support Savings Initiative Program Withdrawal Form

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Child Support Savings Initiative Program
Withdrawal Form
 Use this form to request a withdrawal from your CSSI Learning Quest account.
 You will need to provide copies of receipts for qualified higher education expenses
paid by you (the beneficiary) when requesting a withdrawal payable to yourself,
except as noted below. You will need to provide a bill(s) from the eligible institution
if requesting a check be made payable to the institution.
 See the Learning Quest Handbook for more information on “Qualified Higher
Education Expenses” and “Eligible Educational Institutions.”
 If you have questions, please contact Child Support Services at (888)632-7758.
 Print clearly, preferably in capital letters in black ink. Mail the forms to the address
below. Do not staple.
 Child Support staff will review the form to verify there is a CSSI Learning Quest
account. The form will then be forwarded to Learning Quest to process the
withdrawal request and ensure it is a qualified higher education expense.
Return this form and any other required documents to:
For overnight delivery or registered mail, send to:
Child Support Services, CSSI Program
Child Support Services, CSSI Program
555 S Kansas Ave, 3
Floor
P.O. Box 0497
rd
Topeka, KS 66603
Topeka, KS 66601-0497
1. Noncustodial Parent Information
Noncustodial Parent’s Name (First, Middle Initial and Last Name)
Daytime Phone Number
Noncustodial Parent’s SSN
2. Beneficiary Information
Beneficiary’s Name (First, Middle Initial and Last Name)
Beneficiary’s Street Address
Apartment/Unit
City
State
ZIP
Beneficiary’s SSN

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