Financial Aid Office
2019-2020 Signature Page - Independent Student Worksheet
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 school if you default on a federal student loan, and
(5) will not receive a Federal Pell Grant from more than one school for the same period of time.
If you are the spouse or the student, by signing this application you agree
if asked, to provide information that will verify the accuracy of your completed worksheet. 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 sign
any document related to the federal student aid programs electronically using a personal FSA User ID, you certify that you
are the person identified by the FSA User ID and have not disclosed that FSA User ID to anyone else. 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 worksheet should sign below. The student (and spouse, if
spouse information is given) MUST sign below.
Name: ______________________________________________
Date of Birth: _________________
Phone Number:___________________________
Student ID#: ______________________
Social Security Number:
Marital Status: __________________________________
Date of Marriage, Separation, Divorce, or Widowed: __________________________
Signature: ____________________________________________
Name: ____________________________________________
Date of Birth: _______________________
Social Security Number: ______________________________
Please return this completed worksheet to:
Caldwell Campus
Watauga Campus
2855 Hickory Blvd.
P.O. Box 3318
Hudson, NC 28638
Boone, NC 28607
Fax: 828.726.2709
Fax: 828.297.1729
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