Date_
______________________________
Institutional Student Information Record
R
EAD, SIGN, AND DATE
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 institutional 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 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), you certify that you
are the person identified by the Pin and have not disclosed that PIN 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 form should sign below. The student (and at least one
parent, if parent information is given) MUST sign below.
Student _________________________________________
P
arent _________________________________________
Date _______________________________
Financial Aid Office
3820 Sen. J. Bennett Johnston Ave.
Lake Charles, LA 70615
Phone: 337-421-6545
Email: Financialaid@sowela.edu
www.sowela.edu/financialaid.asp
SOWELA Technical Community College does not discriminate on the basis of race, color, national origin, gender, disability, or age in its programs and activities. The
following person has been designated to handle inquiries regarding the non-discrimination policies:
Title: Compliance Officer
Address: 3820 Sen J Bennett Johnston Ave
Telephone No.: 337-421-6565 or 800-256-0483
Email: complianceofficer@sowela.edu
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