Specific instructions
P
art I -Student or Borrower Identification
Name of Student or Borrower: Enter the name of the student if the request for the student's social security number is being
made because of tuition payments. Enter the name of the borrower if the request for the student's social security number
is being made because of a student loan. Note: If you pay tuition to and have a student loan from the same educational
institution and the student is not the loan borrower, for example, if the loan borrower is the student's parent, complete two
forms W-9S, one for the student and one for the loan borrower.
RCC Student 10 Number: Enter your Rogue Community College Student Identification Number.
Social Security Number: Enter your social security number (SSN). If you have an IRS individual taxpayer identification
number (ITIN) because you are not eligible to obtain an SSN, enter the ITIN. If you do not have an SSN or ITIN and you
have applied for one or you intend to apply for one soon, write "Applied For" in the space provided.
How to Obtain an SSN or ITIN: If you do not have a SSN, apply for one immediately. To apply for an SSN, obtain Form
SS-5, Application for a Social Security Card, from your local Social Security Administration. To apply for an ITIN, obtain
Form W-7, Application for IRS Individual taxpayer Identification Number, from the I RS by calling 1-800-TAX-FORM
(1-800-829-3676) or from the IRS internet website at www.irs.gov
Address: Enter your complete mailing address.
Signature of Student: The student listed above MUST sign this statement to certify correct social security number
and RCC identification number.
Part II -Student Loan Certification
If your loan is a student loan incurred solely to pay for qualified higher education expenses, sign the certification in Part II.
If you do not sign the certification, the lender may not issue or file Form 1098-E for the student loan interest on your
behalf. Do not sign the certification for a mixed use loan because such a loan is not used solely for qualified higher
education expenses. However, you may sign the certification for a revolving line of credit or similar loan if you use the line
of credit solely to pay for qualified higher education expenses.
Qualified Higher Education Expenses: These expenses are the costs of attending an eligible educational institution,
including graduate school. Generally, these costs include tuition, fees, room and board, books, equipment and other
necessary expenses, such as transportation.
Part III -Requester Information
This part is not required to be completed. It is provided for the convenience of the requester to help identify the account to
which this Form W-9S relates. The requester may enter its name and address and a tuition or loan account number.
Penalties
Failure to Furnish Correct SSN. If you fail to furnish your correct SSN to the requester, you are subject to a penalty of $50
by the IRS unless your failure is due to reasonable cause and not to willful neglect.
Misuse of SSN's. If the requester discloses or uses your SSN in violation of Federal Law, the requester may be subject to
civil and criminal penalties.
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to give your correct SSN to persons who must file information
returns with the IRS to report certain information. The IRS uses the numbers for identification purposes and to help verify
the accuracy of your tax return. The IRS may also provide this information to the Department of Justice for civil and
criminal litigation and to cities, states, and the District of Columbia to carry out their tax laws.
The Family Educational Rights and Privacy Act (FERPA) of 1974 (as amended) requires the protection of student records
by educational institutions that receive funds from the U.S. Department of Education or whose students receive such
funds. Except for certain circumstances specified in the FERPA statute and regulations, FERPA prohibits the disclosure of
personally identifiable information from educational records to third parties unless the institution has the consent of the
student.
Print & mail form to:
Rogue Community College 3345 Redwood Hwy Grants Pass, OR 97527
RCC Form (Replacing IRS Form W-9S) Rev. 12/13/2013
RCC Privacy Statement
R
CC is an open institution and does not discriminate. For RCC's non-discrimination policy and a full list of regulatory specific contact
persons visit the following webpage: www.roguecc.edu/nondiscrimination.
