Office of Financial Aid
2019-2020
CERTIFICATIONS OF
STATEMENT OF
CORRECTIONS
(Please complete form using blue or black ink.)
Last Name First Name M.I.
SCC ID#
As certified by the signatures below, all the information provided by my parent and/or myself is true
and complete to the best of my (our) knowledge. I understand that the Office of Financial Aid may
request additional documentation to verify the information below.
I certify that I have not obtained a Bachelor’s Degree.
Initial
I, , certify that my marital status is
Name
(Single/Married/Separated/Divorced/Widowed) as of / / .
Month
Day
Year
Initial
I, , certify that I have been a victim of IRS tax-
Name
Related identity theft and the IRS has been made aware of the tax-related identity theft.
Initial
I, , certify that I did not work or receive income
Name
from working for the year .
Year
Initial
I, , certify that I did not file an IRS Income Tax
Name
Return for the year .
Other:
Year
Initial
.
Initial
WARNING: If you purposely give false or misleading information on this worksheet, you will be
reported to the Department of Education. You may be fined, sentenced to jail, or both.
Student’s Signature: Date:
Parent’s Signature: Date:
(Dependent Students only)
CSC_20 Rev. 3/18/19
