2016–2017 Verification Worksheet

Independent Students with Child Support Paid

Your 2016–2017 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 reported on your FAFSA. To verify that you provided correct information, CASC willcompare 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 Office at CASC. We may need to ask for additional information.If you have questions about verification, contact theFinancial Aid Office as soon as possible so that your financial aid will not be delayed. Your application will not be processed until all of the required documents have been provided.
  1. Student’s Information

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Student’s Last Name Student’s First Name Student’s M.I.Student’s Social Security Number

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Student’s Mailing Address (include apt. no.) Student’s Date of Birth

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City State Zip CodeStudent’sHome Phone Number

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Student’s Email Address Student’s Alternate or CellPhone Number

  1. Child Support Paid by Student and/or Spouse

The student or spouse, who is a member of the student’s household, paid child support in 2015. 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, the age of the child for whom the support was paid and the total annual amount of child support that was paid in 2015 for each child. Please 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/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 receive, or copies of the child support payment checks or money order receipts. Write N/A if the student or spouse did NOT pay child support in 2015.

Name of Person Who Paid Child Support / Name of Person to Whom Child Support was Paid / Name of Child for Whom Support Was Paid / Age of Child for Whom Support Was Paid / Amount of Child Support Paid in 2015
Marty Jones / Chris Smith (example) / Terry Jones / 3 yr. old / $6,000.00
  1. Certification and Signatures

Each person signing this worksheet certifies that all of the information reported on this worksheet is complete and correct. The student must sign this worksheet. If married, the spouse’s signature is optional.

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Student’s SignatureDate

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Spouse’s SignatureDate