2019-2020 Institutional Student
Information Record
Required Signatures for the Free Application
for Federal Student Aid (FAFSA)
Financial Aid
450 North Avenue • Battle Creek, MI 49017-3397
269-965-4123 • FAX 269-966-4089
The federal processor has notied the Financial Aid oce that required signatures were missing from
your 2019-2020 Free Application for Federal Student Aid (FAFSA). By signing this form the Financial Aid
oce will report that the required signatures have been provided.
If you are a student, by signing this form (FAFSA) you certify that you:
1. Will use federal and/or state student nancial 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 school if you default on a federal student loan.
5. Will not receive a Federal Pell Grant for more than one school for the same period of time.
If you are the parent or the student, by signing this application (FAFSA) you agree, if asked, to provide
information that will verify the accuracy of your completed form. This information may include your U.S.
or state income tax forms. Also, you certify that you understand that the Secretary of Education has the
authority to verify information reported on this application (FAFSA) with the Internal Revenue Service
and other Federal agencies. If you purposely give false or misleading information, you may be ned $20,000,
sent to prison, or both.
Everyone whose information is given on this form (FAFSA) should sign below. The student and at least one
parent, whose nancial information was used on the FAFSA must sign below.
Student Name ___________________________________ SS# ____________________
(Please print)
Student Signature______________________________________ Date _______________
Parent Name ___________________________________ SS# ____________________
(Please print)
Parent Signature_______________________________________ Date _______________
Updated 3/19