CERTIFICATION PAGE SIGNATURES
Student ID #________________
READ, SIGN, AND DATE BELOW
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, and (4) will notify your
school if you default on a student loan.
If you are the parent of 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 this form should sign below. The Student (and at least one parent,
if parent information is given) MUST sign below.
PRINT STUDENTS NAME ____________________________________________________________
STUDENT SIGNATURE ______________________________________DATE__________________
PRINT PARENT NAME _______________________________________________________________
PARENT’S SIGNATURE ________________________________________ DATE __________________
Quincy College Financial Aid Office
1250 Hancock Street - Suite 203,
Quincy, MA 02169
