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Student Name: _______________________________________________
Student ID or Star ID: __________________________________________
Address: ____________________________________________________
City State Zip Code
2020 – 2021 FAFSA Signature Page
-This form must be dropped off or mailed in.
We cannot accept photocopies or scanned copies-
If a fee was paid to someone for advice
or for completing this form, that
person must complete this section.
Preparer’s name, firm and address
COLLEGE USE ONLY Federal School Code
D/O 1
Youth
4
FAA Signature
1
DATA ENTRY
USE ONLY:
P * L E
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 sign any document related to the federal
student aid programs electronically using a personal identification number (PIN), username and password,
and/or any other credential, you certify that you are the person identified by that PIN, username and
password, and/or other credential, and have not disclosed that PIN,
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.
104. Date this form was completed
MONTH DAY
2021
105. Student (Sign below)
1
Parent (A parent from Step Four sign below.)
2
Step Seven (Student and Parent):
Read, sign and date.
106. Preparer’s Social Security number (or
107)
107. Employer ID number (or 106)
108. Preparer’s signature and date
1
3300 Century Avenue North
White Bear Lake, MN 55110
Phone: 651-779-3305
A MEMBER OF THE MINNESOTA STATE COLLEGES & UNIVERSITY SYSTEM
AN AFFIRMATIVE ACTION EQUAL OPPORTUNITY EMPLOYER & EDUCATOR
