Student’s Name___________________________________________ Student’s ID Number ___________________
28
00 University Boulevard N | Jacksonville, FL 32211
T 800.558.3467 | F 904.256.7148 Page 2 of 2
No
tary’s Certificate of Acknowledgement
St
ate of ________________________________________________________________________
Ci
ty/County of ___________________________________________________________________
On_______________
______, before me, ____________________________________________,
(Date) (Notary’s name)
per
sonally appeared, ____________________________________________, and provided to me
(Printed name of signer)
on
basis of satisfactory evidence of identification _______________________________________
(Type of government-issued photo ID provided)
to
be the above-named person who signed the foregoing instrument.
WI
TNESS my hand and official seal
(seal) ________________________________________
(Notary signature)
My
commission expires on _____________
____________
Certifications and Signatures
Each person signing below certifies that all of the
information reported is complete and correct.
The student and one parent whose information was
reported on the FAFSA must sign and date.
_______________
____________________________ _________________________
Print Student’s Name Student’s ID Number
_______________
___________________________ _________________________
Student’s Signature Date
_______________
___________________________ _________________________
Parent’s Signature Date
WARNING: If you purposely give false
or misleading information you may be
fined, be sentenced to jail, or both.
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