Child Support Savings Initiative Program Withdrawal Form (Page 3 of 3) in pdf

Child Support Savings Initiative Program Withdrawal Form Page 3

Student ID (required).

For security reasons, a Social Security Number will not be acceptable.

Mailing Address

City

State

ZIP

Check if you would like your check sent expedited delivery (no P.O.

mailboxes permitted). A $10 fee will be applied to your account. With

expedited delivery, your withdrawal check should be received within

three business days once your request is received in good order and

processed.

5. Signature

If the beneficiary is under the age of 18, a parent or guardian must also sign

authorizing this withdrawal.

Withdrawals made payable to an institution

If I have requested the check for this withdrawal to be made payable to an

institution, I certify that the institution is an eligible educational institution and that

the check will be used to pay for qualified educational expenses.

Beneficiary Signature

Date

__________________________________________________________________

______________________

Parent/Guardian Signature

Date

For Official Use Only

Approved by CSS

Date

Child Support Savings Initiative Program Withdrawal Form Page 3