College Connect Locations
SUNO Campus: Miguel Devezin
Bashful Administration Bldg, Rm 210
Phone: 504-286-5007
Fax: 504-286-5213
Email: [email protected]
SUBR Campus: Carey Williams
Stewart Hall, Rm 107
Phone: 225-771-5630
Fax: 225-771-4954
Email: [email protected]
INDEPENDENT STUDENT
Office of Student Financial Aid & Scholarships
L.C. Barnes Administration Bldg, Rm A-43
3050 Martin Luther King, Jr. Drive Shreveport, La 71107
Phone: (318) 670-9221 Fax: (318) 670-6313 Email: [email protected]
CHILD SUPPORT ATTESTATION
9000
STUDENT’S NAME _______________________________ ID ______________
TO BE COMPLETED AND SIGNED BY STUDENT OR SPOUSE WHO PAID CHILD SUPPORT
If both the student and spouse paid child support, please complete two separate forms.
I certify that I paid child support in_____ . I have listed below 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 amount of child support paid in_____ for each child. I also attest that I have
not included these children as members of my household size. (The student or the student’s
spouse can either include these children as members of the household or include the amount
of child support paid but may not include these children as members of the household and also
list child support paid).
Name of Person to Whom Child
Support Was Paid
Name of Child for Whom Child
Support Was Paid
Total Amount of Child Support
Paid in______
Please note that if Southern University at Shreveport believes that the information regarding
child support paid is not accurate, SUSLA may require additional documentation, such as:


A copy of the separation agreement or divorce degree 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 child support payment checks or money order receipts.
Student’s or Spouse’s Name ______________________________________
Student’s or Spouse’s Signature ___________________________________
DATE SIGNED ___________________________
Southern University at Shreveport does not discriminate on the basis of race, color, national origin, gender, age or disability. Title IX Coordinator: Ms. Tilisha T.
Bryant, Administration Building, Room A-43, (318) 670-9210. Section 504 Coordinator: Ms. Jerushka Ellis, Fine Arts Building, Room C04 D, (318) 670-9473.
Revised 03/2016