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354 Richards Hall ... 360 Huntington Ave ... Boston, MA 02115 ...

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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: ________________
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