Independent Child Support Paid Verification (V3) Worksheet
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12015-2016 INDEPENDENT CHILD SUPPORT PAID
VERIFICATION (V3) WORKSHEET
Your FAFSA was selected by the U.S. Department of Education for review in a process called “Verification.” In this process
Missouri S&T is required to compare information from your FAFSA with the information on this worksheet and with any
other required documents. The law states we have the right to ask you for this information and review it for accuracy
under the financial aid program rules (34 CFR, Part 688). Verification must be completed before your financial aid will be
credited to your student account.
INSTRUCTIONS
1. Complete all sections of this worksheet in full.
Incomplete forms will be returned.
2. For Verification Policy please go to:
3. All documents must be submitted by the following deadlines:
Fall 2015 Enrollment: October 31, 2015
Spring 2016 Enrollment: March 1, 2016
4. Please return all documents requested to our office via fax to (573)341-4274, email to
sfa@mst.edu
or mail to
th
G-1 Parker Hall, 300 W 13
St, Rolla, MO 65409-0250.
Last Name
First Name
M.I.
Daytime Phone number (include area code)
Date of Birth
Missouri S&T Student ID#
Child Support Information
Did you or your spouse pay child support in 2014? (Please check one) Yes*
No
*If Yes, complete the chart below.
Legal Name of
Legal Name of Child for
Age of Child
Annual 2014 Amount Paid
Parent/Guardian to Whom
Whom Support Was Paid
Per Child
Support Was Paid
If more space is required, attach a separate page.
Manually sign this Worksheet. Forms with electronic/typed signatures will be returned.
Each person signing certifies that all the information reported is complete and correct. The student must sign this worksheet. (If
married, the spouse’s signature is optional.)
Student
Date
Spouse
Date
Daytime Phone number (include area code)
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, sentenced to jail, or both.
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