Mail: Financial Aid Office
Eastern Wyoming College
3200 West C Street
Torrington, WY 82240
2021-2022
Student Signature and
Certification Form
You did not sign your 2021-2022 Free Application for Federal Student Aid (FAFSA). You may go back online to fafsa.gov and use (or
create) your Federal Student ID (FSA ID) and password to sign your application electronically OR you may complete this form and
submit the original, signed in ink, to the Financial Aid Office at EWC.
___________________________________________________________ ____________________ __________________________
Last Name First Name M.I. EWC Student ID Number Social Security Number (last four digits)
___________________________________________________________ _______________________________________________
Mailing Address (include apartment number) E-mail Address
___________________________________________________________ _______________________________________________
City, ST, Zip Phone Number (include area code)
2021-2022 Institutional Student Information Record
READ, SIGN AND DATE
By signing this Certification Form you, the STUDENT, certify that all of the information you provided
on your 2021-2022 Free Application for Federal Student Aid (FAFSA) as seen on the attached
Institutional Student Information Record (ISIR) or Student Aid Report (SAR) sent to you by the
Department of Education is true and complete to the best of your knowledge and you agree, if asked, to
provide information that will verify the accuracy of your completed form.
By signing this Certification Form you also 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 college if you
default on a federal student loan, and (5) will not receive a federal Pell Grant from more than one college
for the same period of time.
The student MUST sign in ink below.
PRINT student name: _________________________________________ Social Security # (last four digits):____________
Student signature: _____________________________________________________ Date: __________________________
THE DEPARTMENT OF EDUCATION REQUIRES ORIGINAL SIGNATURES ON THIS DOCUMENT.
COPIES OR FAXES OF THIS DOCUMENT ARE NOT ACCEPTABLE.
PLEASE MAIL OR HAND DELIVER ORIGINAL FORM TO EWC.
10/2020
STUDENT CERTIFICATION AND SIGNATURE
