Child Support Paid Form - 2016-2017
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1Florida Agricultural and Mechanical University
Tallahassee, Florida 32307-3100
TELEPHONE: (850) 599-3730
FAX: (850) 561-2730
Division of Student Affairs
Office of Financial Aid
2016-2017
Child Support Paid
Student Name ______________________________________
Student ID___________________
Per the Free Application for Federal Student Aid (FAFSA), the student, spouse (if married), or parent 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,
and the total annual amount of child support that was paid in 2015 for each child.
If more space is needed, provide a separate page that includes the student’s name and ID number at the top.
Name of Person
Name of Person to
Name of Child for
Amount of Child
Who Paid Child
Whom Child Support
Whom Child Support
Support Paid in 2015
Support
was Paid
was Paid
Note: If we have reason to believe that the information regarding child support paid is inaccurate, 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.
Certifications and Signatures
WARNING: If you purposely give false
or misleading information, you may be
Each person signing below certifies that all of the
fined, be sentenced to jail, or both.
information reported is complete and correct. The
student and one parent whose information was
reported on the FAFSA must sign and date.
Student Signature ___________________________________
Date __________________________________
Parent Signature ____________________________________
Date__________________________________
Spouse Signature (if applicable) _________________________
Date__________________________________
Rev. 02/16
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