Signature Page - FAFSA on the Web - Federal Student Aid

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FAFSA on the t{/eb Signature Page

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Student Name: MARIA J KIK

Address:4041 MATHENEY RD NE

Ref: S 017720400 00 Kl
Date Printed: 02111 12016

City, State ZIP: GERVIAS, OR 97026

Step One: Read the followinq.

Students: By signing a signature page and mailing it to us, you certify that you:
1. will use federal and/or state student financial aid only to pay the cost of attending an institution of higher education,
2. are not in default on a federal student loan or have made satisfactory arrangements to repay it,
3. do not owe money back on a federal student grant or have made satisfactory arrangements to repay it,
4. will notify your school if you default on a federal student loan, and
5. will notreceiveaFederal Pell Grantfrommorethanoneschool forthesameperiodoftime.
Students and Parents: By signing a signature page and mailing it to us, you certify that all of the information you provided is true and
complete to the best of your knowledge and you agree, if asked:
1. to provide information that will verify the accuracy of your completed form.
2. to provide U.S. or state income tax forms that you filed or are required to file.
You also certify that you understand that the Secretary of Education has the authority to verify information reported on your application
with the Internal Revenue Service and otherfederal agencies. lf you purposely give false or misleading information, you may be fined up
to $20,000, sent to prison, or both.

Step Two: Siqn below unless otherwise noted.

Student

Signature:

NOT REQUIRED TO

SIGN

Date

Parent Signature:
Date:
lf parental information is provided on the FAFSA, at least ONE parent whose information is provided must sign.
Preparer's Certification: All of the information on this form is true and complete to the best of mv knowledoe.

Signature:

S|GN

Preparer's
NOT REQUIRED TO
Date
lf you or your family paid a fee for someone to fill out this form or to advise you on how to fill it out, that person must sign.

Step Three: Mailthe siqnature paqe to the followinq address:

Federal Student Aid Programs
PO. Box 7652
London. KY 40742-7652
lf you have questions, call the Federal Student Aid Information Center at 1-800-4-FED-AlD (1-800-433-3243) or 1-319-337-5665. lf you
are hearing-impaired and have questions, contact the TTY line at 1-800-730-8913

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Department or Education

Signature Page - FAFSA on the Web - Federal Student Aid

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FAFSA on the Web Signature Page

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Student Name: MARIA J KIK

Address:4041 MATHENEY RD NE

Ref: S 017720400 00 Kl
Date Printed: 02111 /2016

City, State ZIP: GERVIAS, OR 97026

Step One: Read the followinq.

Students: By signing a signature page and mailing it to us, you certify that you:

1.

will usefederal and/orstatestudentfinancial

3.
4.
5.

are noI in default on a federal student loan or have made satisfactory arrangements to repay it,
do not owe money back on a federal student grant or have made satisfactory arrangements to repay it,
will notify your school if you default on a federal student loan, and
will not receive a Federal Pell Grant from more than one school for the same period of time.

2.

aidonlytopaythecostofattendinganinstitutionofhighereducation,

Students and Parents: By signing a signature page and mailing it to us, you certify that all of the information you provided is true and
complete to the best of your knowledge and you agree, if asked:
1. to provide information that will verify the accuracy of your completed form.
2. to provide U.S. or state income tax forms that you filed or are required to file.
You also certify that you understand that the Secretary of Education has the authority to verify information reported on your application
with the Internal Revenue Service and otherfederal agencies. lf you purposely give false or misleading information, you may be fined up
to $20,000, sent to prison, or both.

Step Two: Siqn below unless otherwise noted.

Student

Sionature:

NOT REQUIRED TO

SIGN

Date:

Parent Signature:
Date:
lf parental information is provided on the FAFSA, at least ONE parent whose information is provided must sign.
Preparer's Certification: All of the information on this form is true and complete to the best of my knowledge.

Signature:

S|GN

Preparer's
NOT REQUIRED TO
Date
lf you or your family paid a fee for someone to fill out this form or to advise you on how to fill it out, that person must sign.

Step Three: Mailthe siqnature paqe to the followinq address:

Federal Student Aid Programs
PO. Box 7652
London, KY 40742-7652
lf you have questions, call the Federal Student Aid Information Center at 1-800-4-FED-AID (1-800-433-3243) or 1-319-337-5665. lf you
are hearing-impaired and have questions, contact the TTY line at 1-800-730-8913

Federar student Aid Loso and

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Department of Education