Financial Aid Office
1200 16th Street
Golden CO 80401
303-273-3301
303-384-2252 fax
finaid@mines.edu

Child Support Paid

Student: _______________________________________ Campus Wide I.D.#:________________________

It was indicated on the FAFSA that a member of the student’s household, paid child support in 2015. List below
the name of the person(s) who paid the child support, the name of the person(s) 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 Who
Name of Person to Whom
Name of Child for Whom
Amount of Child
Paid Child Support
Child Support was Paid
Support Was Paid
Support Paid in
2015





















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 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 electronic payment records.

By signing below, I certify that all the information reported on this form is complete and correct. WARNING: If
you purposely give false or misleading information on this worksheet, you may be fined, be sentenced
to jail, or both.


Student ____________________________________

Parent (if the student is dependent) _____________________________________

Date______________