PARENT CERTIFICATION AND SIGNATURE
Mail: Financial Aid Office
Eastern Wyoming College
3200 West C Street
Torrington, WY 82240
2014-2015 Parent
Signature & Certification Form
Your parent did not sign your 2014-2015 Free Application for Federal Student Aid (FAFSA). You may go back online to fafsa.gov and
have your parent use his/her PIN to sign your application electronically OR you may have your parent complete this form and submit the
original to the Financial Aid Office at EWC.
______________________________________________________________ ________________________________________
Last Name First Name M.I. EWC Student ID Number
______________________________________________________________ ________________________________________
Address (include apartment number) Social Security Number (last four digits)
______________________________________________________________ ________________________________________
City, ST, Zip Phone Number (include area code)
2014-2015 Institutional Student Information Record
READ, SIGN AND DATE
By signing this Certification Form you, the PARENT, agree, if asked, to provide information that will verify the accuracy
of your student’s FAFSA. 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 the FAFSA with the Internal Revenue Service and other Federal agencies. If you sign any document related to the
Federal Student Aid Programs electronically using a Personal 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.
The parent MUST sign in ink below.
PRINT student name: _______________________________________ Social Security # (last four digits):____________
PRINT parent name: ________________________________________ Social Security # (last four digits):____________
PARENT signature:__________________________________________________ Date:__________________________
THE DEPARTMENT OF EDUCATION REQUIRES ORIGINAL SIGNATURES ON THIS DOCUMENT.
COPIES OR FAXES OF THIS DOCUMENT ARE NOT ACCEPTABLE.
PLEASE MAIL ORIGINAL FORM TO EWC.
2/12/14
click to sign
signature
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