UNIVERSITY OF NEW MEXICO STUDENT FINANCIAL AID OFFICE VERIFICATION OF CHILD CARE EXPENSES FALL/SPRING 2017-2018 Student’s Printed Name UNM ID Number Telephone Number E-mail Address Please provide the information requested below for your dependents age 12 or under, whom you included in questions 51, 52 and 95 on your Free Application for Federal Student Aid (FAFSA), who will be in child care during FALL/SPRING SEMESTER(S). Do not include private school tuition, including Pre-K or kindergarten. Child Care Provider’s Name Child Care Provider’s Address COMPLETE THIS SECTION ONLY FOR FALL/SPRING SEMESTER(S) Child’s Name Age Circle day(s) of the week in No. of hours in Amount you Amount paid by child care child care pay another source each week for child care each week each week M T W TH F S M T W TH F S M T W TH F S M T W TH F S Is your spouse attending UNM during 2017-2018? Yes No If “Yes,” please list your spouse’s name and UNM ID number below: Spouse’s Name Spouse’s UNM ID Number I hereby certify that the information I provided is complete and correct. I understand that it is my obligation to notify the Student Financial Aid Office if the amount I am paying for child care changes at anytime during the academic year. Student’s Signature Date Signed I hereby certify that the above information is correct to the best of my knowledge and belief. Child Care Provider’s Signature Printed Name Date Signed Telephone Number The University of New Mexico is an Equal Opportunity/Affirmative Action institution. Pursuant to the Americans with Disabilities Act, if you require this information in alternative format or have special needs, please contact the Office of Student Financial Aid for assistance. Rev. 10/16
UNIVERSITY OF NEW MEXICO STUDENT FINANCIAL AID OFFICE VERIFICATION OF CHILD CARE EXPENSES FALL/SPRING 2017-2018 Student’s Printed Name UNM ID Number Telephone Number E-mail Address Please provide the information requested below for your dependents age 12 or under, whom you included in questions 51, 52 and 95 on your Free Application for Federal Student Aid (FAFSA), who will be in child care during FALL/SPRING SEMESTER(S). Do not include private school tuition, including Pre-K or kindergarten. Child Care Provider’s Name Child Care Provider’s Address COMPLETE THIS SECTION ONLY FOR FALL/SPRING SEMESTER(S) Child’s Name Age Circle day(s) of the week in child care No. of hours in child care each week Amount you pay for child care each week Amount paid by another source each week M T W TH F S M T W TH F S M T W TH F S M T W TH F S Is your spouse attending UNM during 2017-2018? Yes No If “Yes,” please list your spouse’s name and UNM ID number below: Spouse’s Name Spouse’s UNM ID Number I hereby certify that the information I provided is complete and correct. I understand that it is my obligation to notify the Student Financial Aid Office if the amount I am paying for child care changes at anytime during the academic year. Student’s Signature Date Signed I hereby certify that the above information is correct to the best of my knowledge and belief. Child Care Provider’s Signature Printed Name Date Signed Telephone Number The University of New Mexico is an Equal Opportunity/Affirmative Action institution. Pursuant to the Americans with Disabilities Act, if you require this information in alternative format or have special needs, please contact the Office of Student Financial Aid for assistance. Rev. 10/16
childcare-verification-17-18.docx