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STUDENT INFORMATION First Name Middle Initial Student Marital Status O SINGLE O MARRIED/REMARRIED O SEPARATED O DIVORCED/WIDOWED Last Name Social Security Number Month/Year Student was married separated divorced or widowed Date of Birth Are you Male or Female O MALE / MM/YYYY PARENT INFORMATION FOR PARENTS REPORTED ON YOUR FAFSA FATHER/STEPFATHER INFORMATION MOTHER/STEPMOTHER INFORMATION Parent s Marital Status Month/Year Parents/Stepparents were married separated divorced or widowed Date Signed STUDENT S SIGNATURE. Free Application for Federal Student Aid FAFSA Signature Page READ COMPLETE SIGN AND DATE If you are the student by signing this application 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 college if you default on a federal student loan and 5 will not receive a Federal Pell Grant from more than one college for the same period of time. If you are the parent or the student by signing this application you agree if asked to provide information that will verify the accuracy of your completed form* This information may include U*S* or state income tax forms that you filed or are required to file. Also you certify that you understand that the Secretary of Education has the authority to verify information reported on this application with the Internal Revenue Service and other federal agencies. If you sign any document related to the federal student aid programs electronically using a Person Identification Number PIN you certify that you are the person identified by the PIN and have not disclosed that PIN to anyone else. If you purposely give false or misleading information you may be fined 20 000 sent to prison or both. Everyone whose information is given on this form should complete the information below. The student and at least one parent if parent information is given MUST complete the information below. If you are the parent or the student by signing this application you agree if asked to provide information that will verify the accuracy of your completed form* This information may include U*S* or state income tax forms that you filed or are required to file. Also you certify that you understand that the Secretary of Education has the authority to verify information reported on this application with the Internal Revenue Service and other federal agencies. Also you certify that you understand that the Secretary of Education has the authority to verify information reported on this application with the Internal Revenue Service and other federal agencies. If you sign any document related to the federal student aid programs electronically using a Person Identification Number PIN you certify that you are the person identified by the PIN and have not disclosed that PIN to anyone else. .