Mail: Financial Aid Office
Eastern Wyoming College
3200 West C Street
Torrington, WY 82240
2017-2018
Student Signature and
Certification Form
You did not sign your 2017-2018 Free Application for Federal Student Aid (FAFSA). You may go back online to fafsa.gov and use (or
create) your Federal Student ID (FSA ID) and password to sign your application electronically OR you may 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 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.
The student MUST sign in ink below.
PRINT student name: _________________________________________ Social Security # (last four digits):____________
Student 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
STUDENT CERTIFICATION AND SIGNATURE
