2015-2016 Center for Student Financial Aid 02/2015 California State University, Los Angeles For office use only: 5151 State University Drive, SA 124 Los Angeles, CA 90032-8402 Phone: (323) 343-6260 Fax: (323) 343-3166 Print Form Reset Form Verification of Child Support Paid __________________________________ Last Name ___________________________ _____ First Name M.I. ______________________________________ Campus Identification Number (CIN) Complete this form if you, your spouse (if married), or one (or both) of your parents paid child support in 2014.  Either I, my spouse (if married), or one (or both) of my parents paid child support in 2014. It has been indicated below the name of the person who paid the child support, the name of the person to whom the child support was paid, the names for the children for whom child support was paid, and the total annual amount of child support that was paid in 2014 for each child Note: The following additional documentation may be required if there is reason to believe that the information regarding child support paid is inaccurate. The Financial Aid Office will inform you if either or both of the following documentation is required. • A signed statement from the individual receiving the child support certifying the amount of child support received; or • Copies of the child support payment checks, money order receipts, or similar records of electronic payments having been made. (If you need more space, attach a separate page). Name of Person Who Paid Child Support Name of Person to Whom Child Support was Paid Name of Child for Whom Support Was Paid Marty Jones Chris Smith (example) Terry Jones Amount of Child Support Paid in 2014 $ 6,000.00 $ $ $ $ $ $  Check here if there was a reporting error on the FAFSA and there was ‘NO’ child support paid in 2014. STUDENT CERTIFICATION STATEMENT The student must sign this worksheet. If married, the spouse’s signature is optional. For dependent students, the student and one parent must sign and date. I/we certify that all of the information reported on this sheet is complete and correct. Student’s Signature ______________________________________________ Date: ________________________________________ Spouse’s or Parent’s Signature _____________________________________ Date: ________________________________________