2020 - 2021
Signature Page - Independent Student Worksheet
If you are the student, by signing this application 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 school if youdefault on a federal student loan, and
(5) will not receive a Federal Pell Grant from more than one school for the same period of time.
If you are the spouse or the student, by signing this application you agree if asked, to provide information that will
verify the accuracy of your completed worksheet. 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 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 FSA User ID, you certify that you are the person identified
by the FSA User ID and have not disclosed that FSA User ID to anyone else. If you purposely give false or misleading
information, you may be fined $20,000, sent to prison, or both.
Everyone whose information is given on this worksheet should sign below. The student (and spouse, if spouse
information is given) MUST sign below.
Date of Birth:
Phone Number:
Student ID#:
Social Security Number:
Marital Status:
Date of Marriage, Separation, Divorce, or Widowed:
Date of Birth:
Social Security Number:
Return completed worksheet(s) to:
Caldwell Community College and Technical Institute
Office of Financial Aid
E-mail finaid@cccti.edu
Caldwell Campus 2855 Hickory Blvd., Hudson, NC 28638 Watauga Campus PO Box 3318, Boone, NC 28607
Fax: 828.726.2709 Fax: 828.297.1729
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