Dependent Student Child Support Verification Form - 2017-2018 Page 2
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2Student’s Name ___________________________
Student’s ID Number ________________________
Note: If we have reason to believe that the information regarding child support paid is not accurate, we may
require additional documentation, such as:
A copy of the separation agreement or divorce decree 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;
or
Copies of the child support payment checks or money order receipts
Certifications and Signatures
C.
Each person signing below certifies that all of the information reported is complete and correct. The student and
one parent whose information was reported on the FAFSA must sign and date.
WARNING: If you purposely give false or misleading information you may be fined, be sentenced to
prison, or both.
_______________________________________________________
_____________________________
Print Student’s Name
Student’s ID Number
_______________________________________________________
_____________________________
Student’s Signature
Date
_______________________________________________________
Print Parent’s Name
_______________________________________________________
_____________________________
Parent’s Signature
Date
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