Financial Aid Office ● 197 Franklin St. • Auburn, NY  13021

   315-255-1743 ext. 2470 • Fax 315-252-2185






Student’s Printed Name                                                                                                          Cayuga ID #


You indicated on your FAFSA that you, your spouse, or your parents paid child support in 2013.  Please complete the following form and return it to the Financial Aid Office to continue the processing of your financial aid application.


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 2013 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 Paid Child Support

Name of Person to Whom Child Support was Paid

Name of Child for Whom Support Was Paid

Amount of Child Support Paid in 2013

Marty Jones (example)

Christine  Smith (example)

Terry Jones (example)

$6.000 (example)


















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 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.


I (we) certify under penalty of federal law that all of the information reported on this form is complete and accurate.


Student Signature_____________________________________________     Date:_______________________



Dependent Student’s Only


Parent Printed Name________________________________________________________________________


Parent Signature_______________________________________________     Date:______________________