Form - 10
Mail to: NCC Financial Aid
P.O. Box 7488
Rocky Mount, NC 27804
2020-2021
Nash Community College
Signature/Certification Page
Full Name: ___________________________________________________
NCC Student ID Number: __________________________________
READ, SIGN, AND DATE
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 you default 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 parent or the student, by signing this application 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 with the Internal
Revenue Service and other Federal agencies. 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 the FAFSA application should sign below. The
student (and at least one parent, if parent information is given) MUST sign below.
Student Signature Required: _______________________________________ Date _______________
Parent Signature Required: ________________________________________ Date______________
