2015-2016 PARENT CHILD SUPPORT PAID
Your 2015-2016 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. The law says that before awarding Federal Student Aid, we may ask you to confirm the
information you and your spouse (if applicable) reported on your FAFSA. To verify that you provided correct information GSU will compare your FAFSA with the information on this worksheet and with any
other required documents. If there are differences, your FAFSA information may need to be corrected. You must complete and sign this worksheet, attach any required documents, and submit the form and
other required documents to the financial aid administrator at GSU. We may need to ask for additional information in the future. If you have questions about verification, contact our office as soon as possible so
that your financial aid will not be delayed.
STUDENT INFORMATION
Please complete this verification form and provide copies of all requested paperwork to Governors State University.
Incomplete paperwork will not be accepted, thereby delaying the processing of your financial aid award.
Student Name: _________________________________________________
Please Print
Last
First
GSU ID #____________________
Last 4 digits of SS#:__________________
Permanent Home Address: ___________________________________________________________________________________________________________ ______
City
State
Zip Code
Student’s Date of Birth: ____________________________Home Phone #: __________________________________Cell #: ______________________________
Email Address: ______________________________________________________
CHILD SUPPORT PAID – CALENDAR YEAR 2014
One or both of your parents reported child support payments in 2014 on the Free Application for Federal Student Aid (FAFSA).
Please complete the below section with the specific information requested.
• Only include amounts of child support paid to those not listed in your household on the verification worksheet.
• Do not include any amounts of child support received by members of your household in this section.
• If you did not pay child support in 2014, mark “N/A” in Name of Person Who Paid Child Support and “0” in Amount of
Child Support Paid.
Name of Person Who Paid
Child Support
Marty Jones
Name of Person to Whom
Child Support was Paid
Chris Smith (example)
Name of Child for Whom
Support Was Paid
Terry Jones
Amount of Child Support
Paid in 2014
$6000.00
CHILD SUPPORT DOCUMENTATION
I have provided copies of acceptable documentation of the payment of child support. Select one:




Copies of the child support checks or money order receipts.
No Child support paid – calendar year 2014.
A copy of the separation agreement or divorce decree that shows that amount of child support provided.
A statement from the individual receiving the child support showing the amount provided.
CERTIFICATION AND SIGNATURES
Each person signing this worksheet certifies that all of the information reported on it is complete and correct. The student and
one parent must sign and date.
____________________________________________________________________
Student’s Signature
Date
__________________________________________________________________
Parent Signature
Date
WARNING: If you purposely give false or misleading
information on this worksheet, you may be fined, be
sentenced to jail, or both.
CRI CODE: FAC15CSP