Uam 2015-16 Child Support Paid Verification Form
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12015-16 Child Support Paid Verification
(FADCSE or FAICSE) Federal Student Aid Programs
Toll Free: 1-800-226-2643 Phone: (870) 460-1050 Fax: (870) 460-1450
University of Arkansas at Monticello Financial Aid Office P.O. Box 3470 Monticello, AR 71656
Your federal financial aid application was selected for review in a process called “Verification.” This process requires that we verify
the information you reported on your FAFSA regarding Child Support Paid.
We cannot process your financial aid until verification has been completed, so please provide the required information as soon as possible.
Student Information
Last Name
First Name
M.I.
SSN
UAM Student ID #
Street Address
Date of Birth
City
State
Zip Code
Home Phone #
Cell Phone #
Child Support Paid
Did you or any member of your household (your parents’ household if you are a dependent student) pay child support in 2014?
Yes (Complete the chart below)
No
Name of Person Who Paid
Name of Person to Whom
Name and Age of Child for
Annual Amount of Child Support
Child Support
Child Support was Paid
Whom Support was Paid
Paid per Child in 2014
*If more space is required, attach a separate sheet. Please include your name and UAM ID number on all pages.
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, or similar records of electronic payments having been
made.
Sign this Worksheet
Each person signing this form certifies that all the information reported on it is complete and correct.
WARNING: If you purposely give
false or misleading information on
Student
Date
this worksheet, you may be fined,
sentenced to jail, or both.
Parent (if dependent) Spouse(if married)
Date
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