midlandstech.edu
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PO Box 2408
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Columbia, SC 29202
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803.738.7792
student financial services
2019-2020 SIGNATURE
CERTIFICATION PAGE
YOU MUST READ THIS CERTIFICATION AND SIGN BELOW
CERTIFICATION
By signing this 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, and (4) will notify your college if
you default on a federal student loan, and (5) will not receive a Federal Pell Grant for more than one
college for the same period of time.
By signing this form 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 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 this application with the Internal Revenue Service and
other federal agencies. If you purposely give false or misleading information, you may be fined up to
$20,000, sent to prison, or both.
STUDENT SIGNATURE
Student Signature Date
PARENT SIGNATURE (must be signed by parent whose information was used to complete the FAFSA).
Parent Signature Date
NAME (Print)
STUDENT MTC ID
SD-19-5256A3-03-19
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