20CSIGS 1/16/2020
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.
__________________________________________________________________
Student Last Name First Name MI
_________________________________
HCC ID Number
PLEASE READ before you SIGN and DATE this form.
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 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.
If you are the parent or the student, by signing this application you certify that all of the
information you provided 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. This
information may include U.S. or state income tax forms that you filed or are required to file.
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 electronically sign any document related to the federal student
aid programs using an FSA ID (username and password) and/or any other credential, you
certify that you are the person identified by that username and password and/or other
credential, and have not disclosed that username and password and/or other credential to
anyone else. If you purposely give false or misleading information, you may be fined up to
$20,000, sent to prison, or both.
Student Signature: ________________________________ Date ____________________
Parent Signature: _________________________________ Date ____________________
(Required for dependent students)
Student Financial Aid Office
11400 Robinwood Drive
Hagerstown, MD 21742
finaid@hagerstowncc.edu
FAX: 301-791-9165
FAFSA
Signature Form
Student Financial Aid Office
11400 Robinwood Drive
Hagerstown, MD 21742
Phone: 240-500-2473
finaid@hagerstowncc.edu
FAX: 301-791-9165
