Form #1045-Cs - Statement Of Child Support Step Up For Students

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#1045-CS
Statement of Child Support
Step Up For Students
Application # ______________
This is to certify that I, _______________________________________________________________
Full name of person who provides child support
provide monthly child support to ________________________________________________________.
Full name of applicant
I give the person noted above $ ______________ each month as child support.
Monthly Amount
For:
Child’s Name ________________________________________________________________________
Child’s Name ________________________________________________________________________
Child’s Name ________________________________________________________________________
Child’s Name ________________________________________________________________________
Child’s Name ________________________________________________________________________
Under penalties of perjury, I certify that the information presented is true and accurate to
the best of my knowledge and belief. The undersigned further understands that providing
false representations herein constitutes an act of fraud. False, misleading or incomplete
information may result in the denial of the scholarship application or revocation of a
scholarship award.
_________________________________________________________________
____________
Signature
Date
SUFS1045CSeng.2012

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