OFFICE OF FINANCIAL AID
4525 Education Park Drive, Schnecksville, PA 18078
P 610
.799.1133| F 610.799.1798
E finaid@mymail.lccc.edu
2020-2021 Institutional Student Information Record Page
Required Signature(s) for the FAFSA Application
Student Name Student ID
Instructions:
READ, SIGN, AND DATE
If you are the student, by signing this application you certify that you
(1
) w
ill 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
) wi
ll not receive a Federal Pell Grant from more than one college for the same period of tim
e.
I
f you are the parent of 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. 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 Federal Student Aid
ID (FSA ID), you certify that you are the person identified by the FSA ID and have not disclosed that FSA 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 the FAFSA form should sign below. The student (and at least one parent, if
parent information is given) MUST sign below.
Student Signature __________________________________________________ Date: _______________
Print Student Name _____________________________________________________________________
Parent Signature ___________________________________________________ Date: ________________
Print Parent Name _______________________________________________________________________
3. Return this form in person or by mail ONLY (NOT FAX OR EMAIL) to the Office of Financial Aid.
OFFICE USE: RRAAREQ Code - SIGN or SIGNP
(WET SIGNATURES ARE REQUIRED)
