354 Richards Hall ... 360 Huntington Ave ... Boston, MA 02115 ...
354 Richards Hall 360 Huntington Ave Boston, MA 02115 fax: 617.373.8735 email: [email protected] www.northeastern.edu/financialaid 2015-2016 Child Support Paid Verification Student’s Name: _________________________ NU ID: _______________________ You must submit this form because on your application(s) for financial aid you have reported that you or one of your parents (if you are a dependent student) included in the household paid child support in 2014. Please complete, sign, and date this form. If you or one of your parents included in the household on your financial aid application(s) did not pay child support, write zero ($0) as the total amount of child support paid. Name of the person(s) who paid the child support: ______________________________ Name of the person(s) to whom child support was paid: __________________________ Name(s) and ages of child(ren) for whom support was paid: _______________________ ________________________________________________________________________ Total amount of child support paid in 2014: $___________________________________ 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 or divorce decree that shows the amount of child support to be provided; 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. Certification and Signature Each person signing below certifies that all of the information reported is complete and correct. Student Signature: ________________________________ Date: ________________ Parent Signature (if Dependent): _______________________________ Date: ________________