Child Support Worksheet Dependent Student
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1Child Support Paid
Dependent Student
ACADEMIC YEAR 2015-2016
Your 2015-2016 Free Application for Federal Student Aid (FAFSA) was selected for review. The law
Send Completed Form To:
requires that before finalizing your financial aid application, you must confirm the information you and
your parents reported on your FAFSA. To verify that you provided correct information, you must
University of Rhode Island
complete this form and forward it to the University of Rhode Island so that we can compare your
Enrollment Services Green Hall
FAFSA with the information on this worksheet. Please complete this form carefully as missing or
6 Rhody Ram Way
incomplete information will delay URI from finalizing your financial aid application. If there are
Kingston, RI 02881 USA
differences, your FAFSA information will be corrected by URI.
You and at least one parent must complete and sign this worksheet, attach any required
Phone: (401) 874-9500
documents, and submit all information to the address provided on the right.
Fax: (401) 874-2002
Website:
Has one of the parents included in the household or the student paid child support in 2014?
Yes. Complete the chart and certification below.
No. Complete certification below.
List below the names of the persons who paid the child support, the names of the persons to whom the child support was
paid, the names of the children for whom the child support was paid, and the total annual amount of child support that was
paid in 2014 for each child.
If more space is needed, provide a separate page that includes the student’s name and ID number at the top.
Name of Person Who Paid
Name of Person to Whom
Name and Age of Child for
Amount of Child Support Paid
Child Support
Child Support was Paid
Whom Support Was Paid
in 2014
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.
WARNING: If you purposely give false or misleading information you may be fined, be sentenced to jail, or both.
CERTIFICATION:
Each person signing below certifies that all of the information reported is complete and correct.
________________________________________
________________________
Print Student’s Name
Student’s ID Number
________________________________________
________________________
Student’s Signature
Date
________________________________________
________________________
Parent’s Signature
Date
The University of Rhode Island is an equal opportunity employer committed to the principles of affirmative action
Rev. 02/2015
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