Submit this completed form and all supporting documents to Lamar State College Port Arthur Financial Aid Office using your preferred method.
Mail: LSCPA Office of Financial Aid ▪ PO Box 310 ▪ Port Arthur, TX 77641 Drop off: 304 Student Center
Scan and email: FinancialAid@lamarpa.edu Fax: 409-984-6021
Revised 10/29/2019
SIGNED SELF-CERTIFICATION STATEMENT
BUSINESS ASSETS
Student Information
Name__________________________________________________________________ ID # _________________________
Directions
Family-owned and controlled small businesses (which can include farms) that have 100 or fewer full-time or full-time
equivalent employees are not included as Business Assets on the Free Application for Financial Aid (FAFSA). “Family-
owned and controlled” means that more than 50% of the business is owned by persons who are directly related or are or
were related by marriage.
Your tax return shows that you own a business. Please fill out the certification statement if your business meets the
definition of a family-owned and controlled small business.
Certification Statement
I, _______________________________________________________, verify the following: that my business income or
Student(Spouse) or Parent(Step-Parent)
loss shown on my federal tax return is a family-owned small business, one that has 100 or fewer full-time (or full – time
equivalent) employees and is owned and controlled by myself.
Certification and Signatures
I (we) certify that all of the information on this form is completed and correct.
W
ARNING: If you purposely give false or misleading information, you may be fined, sent to prison, or both.
__
________________________________________________________________ ___________
Signature of Student/Spouse or Parent/Step-Parent Date
