Mail: Financial Aid Office
Eastern Wyoming College
3200 West C Street
Torrington, WY 82240
2017-2018
Parent Signature and
Certification Form
Your parent did not sign your 2017-2018 Free Application for Federal Student Aid (FAFSA). You may go back online to fafsa.gov and
have your parent use (or create) his/her Federal Student ID (FSA ID) and password to sign your application electronically OR you may
have your parent complete this form and submit the original, signed in ink, to the Financial Aid Office at EWC.
___________________________________________________________ ____________________ __________________________
Last Name First Name M.I. EWC Student ID Number Social Security Number (last four digits)
___________________________________________________________ _______________________________________________
Mailing Address (include apartment number) E-mail Address
___________________________________________________________ _______________________________________________
City, ST, Zip Phone Number (include area code)
2017-2018 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 Federal Student ID (FSA ID) and password, you certify that you are
the person identified by the FSA ID and have not disclosed that FSA ID 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.
11/2016
PARENT CERTIFICATION AND SIGNATURE
