2019-2020 Certification and Signature Page
Please Type or Print clearly in BLUE or BLACK ink
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,
(3) do not owe money back on a federal student grant, (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 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. federal 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.
The student (and at least one parent, if parent information is given) MUST sign below. Each person signing below
certifies that all of the information reported is complete and correct.
Student: ______________________________________________Student ID #: _______________________________
(Please print clearly)
Student Signature:___________________________________________ Date:________________________________
Parent Signature: ___________________________________________ Date: ________________________________
Please submit this worksheet to the Office of Financial Aid!
As set forth in full in the Student Handbook/Course Catalog, Southern Crescent Technical College is an Equal Opportunity Institution and does not discriminate on the basis of race, color,
national origin, sex, age or disability.
Revised 6-27-19
Office of Financial Aid
501 Varsity Road 1533 Hwy 19 South 300 Lakemont Drive
Griffin, GA 30223 Thomaston, GA 30286 McDonough, GA 30253
770-228-7368 p 706-646-6386 p 770-914-4411 p
770-229-3029 f 706-646-6063 f 770-229-3236 f
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