Student Aid Report

WWW.FAFSA.ED.GOV

16
,2
00
8

STUDENT AID REPORT
2009 - 2010
1-800-4-FED-AID (TTY: 1-800-730-8913)

APRIL 22, 2009
000001C001

OMB No. 1845-0008

DATA RELEASE NUMBER (DRN): 9755
EXPECTED FAMILY CONTRIBUTION (EFC): 14595*C

JOHN SMITH
742 EVERGREEN TERRACE
SPRINGFIELD OH 55555

BE

R

Dear JOHN SMITH,
Your Student Aid Report (SAR) summarizes the information you submitted on your 2009 - 2010 Free
Application for Federal Student Aid (FAFSA).

SE
PT
E

M

Application Status (review the checked boxes)
Your FAFSA appears to be complete. Review the data on pages 3-10 of your SAR and make corrections or updates
if necessary. The school(s) listed on your FAFSA will receive your information.
Your FAFSA has been selected for verification. Verification is a process where your school confirms the data you
reported on your FAFSA. Your school has the authority to contact you for documentation that supports income and
other information that you reported on your FAFSA.

DA
TE
:

Federal Student Aid Eligibility (review the checked boxes)

The data submitted on your FAFSA is used to calculate your Expected Family Contribution (EFC), which is 14595.
The EFC is not the amount of money that your family must provide. Rather, you should think of the EFC as an index that
colleges use to determine how much financial aid you would receive if you were to attend their school. Financial aid
may include grants, loans, and/or work-study. This award information will vary from college to college because the cost
of attending each is different. Please note that your EFC is subject to change if you update or correct your FAFSA.

DR

AF

T

Based on your EFC it appears that you may be eligible for a Federal Pell Grant. You may also be eligible for other
Federal grants, low-interest student loans, and work-study opportunities.
We sent your information to other federal agencies to verify your eligibility for federal student aid and there appears
to be an issue with the information provided on your application. Review the checklist on page 3 for instructions
on how to resolve these issues.

You should keep this SAR for your records!
R5EN000001 999

PAGE 1 OF 10

2009-2010 STUDENT AID REPORT
The Office of Management and Budget (OMB) wants you to know that:

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of
information unless it displays a valid OMB control number. The valid OMB control number for this information
collection is 1845-0008. The time required to complete this information collection is estimated to be an average of
10 to 34 minutes, including the time to review instructions, search existing data resources, gather the data needed,
and complete and review the information collected. If you have any comments concerning the accuracy of the
time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington,
DC 20202-4651. If you have any comments or concerns regarding the status of your individual submission of this
form, write directly to: Federal Student Aid Information Center, P.O. Box 84, Washington, DC 20044.
By answering questions 104a through 104h, and signing the Free Application for Federal Student Aid (FAFSA), you
give permission to the U.S. Department of Education to provide information from your application to the college(s)
listed in Step Six. You also agree that such information is deemed to incorporate by reference the certification
statement in Step Seven of the financial aid application. To learn more about the Privacy Act and how your
information may be used, you may refer to page 4 of the paper FAFSA or the Privacy Act link on FAFSA on the Web.
To protect the confidentiality of your application data, you should never give, share or disclose your Federal Student
Aid PIN with anyone, including commercial service providers that provide assistance with the financial aid process.
You should keep your PIN in a safe location. If you think your PIN has been compromised, please go to the Federal
Student Aid PIN web site at www.pin.ed.gov and change your PIN.
WARNING: If you are convicted of drug distribution or possession, for an offense that occurred while you were

receiving Title IV aid, your eligibility for Title IV student financial aid is subject to suspension or termination. If your
drug conviction status changes at any time during the 2009-2010 award year, you must update your answer to
question 23.

Only For Use by Financial Aid Office (skip to next page to begin your review of the data included in your SAR)
This information will be used by your Financial Aid Administrator to determine your eligibility for student aid.
Y
SAR C Flag:
4A
Application Source:
4A
Transaction Source:
Processed Record Type:
Duplicate SSN Flag:

Dependency Status: D
Dependency Override: Y
Professional Judgment: Y
Reprocessing Code:
Special Circumstances: 1

MONTHS:
1
PRIMARY EFC: 01799
SECONDARY EFC: 00000
PC:
SIC:
Auto Zero EFC Flag:
MATCH FLAGS:
SSN Match Flag:
DHS Match Flag:
DHS Sec. Conf. Flag:
NSLDS Match Flag:

Y

SNT Flag:

4

Selective Service Registration Flag: Y
DHS Verification #: 999999999999999
VA Match Flag:
1
NSLDS Results Flag:
01
NSLDS Transaction Number:

ABCDEFG
01/01/2009
01/01/2009
Y

2
3
4
5
6
7
8
9
10
11
12
03398 04997 06596 08195 09794 11393 12992 14595 14595 14595 14595
00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000

2

Y

COMMENTS:
R5EN000001 999

Rejects Met:
Application Receipt Date:
Transaction Receipt Date:
Verification Flag:

PAGE 2 OF 10

Pell Eligible Flag:

Y

Selective Service Match:
C
SSA Citizenship Code:
8
FSSN Match Flag:
4
MSSN Match Flag:

2009-2010 STUDENT AID REPORT
COMMENTS ABOUT YOUR INFORMATION
WHAT YOU MUST DO NOW! (Use the checklist below to make sure that all of your issues are resolved.)
The National Student Loan Data System (NSLDS) indicates that one or more of your federal student loans have been
discharged. If you have questions, contact the financial aid office at your school.
If you need to make corrections to your information, you may either make them online at www.fafsa.ed.gov, or by using
this SAR. You must use your Federal Student Aid PIN to access your record online. If you need additional help with your
SAR, contact your school's financial aid office or the Federal Student Aid Information Center at 1-800-4-FED-AID
(1-800-433-3243). If your mailing address or e-mail address changes, you can make the correction online, send in the
correction on your SAR, or call 1-800-4-FED-AID and ask a customer service representative to make the change for you.

R5EN000001 999

PAGE 3 OF 10

2009-2010 STUDENT AID REPORT
Summary of Federal Student Loans (review the loan totals listed below)

The information below is the total amount of Title IV student loans that you owe as currently reported to us by your
loan holder(s). These loans are administered by the U.S. Department of Education (ED). You should confirm that
these loan totals are correct. You can use your Federal Student Aid PIN to view details on the individual loans that
make up these totals at the National Student Loan Data System (NSLDS) web site at www.nslds.ed.gov. For more
information about your Federal Student Aid PIN, go to www.pin.ed.gov. If you feel that the amounts listed on this
page are incorrect, or you have other questions related to a loan, you should contact the loan servicer indicated on
the NSLDS web site. You can obtain general information about each of the types of loans that are listed below by
visiting our studentaid.ed.gov web site.
Note that the 'Subsidized' and 'Unsubsidized' amounts include the appropriate portions of any Consolidation
Loans you may have. If there is an amount listed for 'FFEL Unallocated Consolidation Loans' it is because we
could not determine whether those balances were subsidized or unsubsidized.
Remember you are responsible for repaying all of the amounts that you borrow, plus interest. As a general rule,
with an assumed interest rate of 5%, the monthly payment amount over a ten-year repayment period would be
approximately $10.61 for every $1,000 that you borrowed. Of course your actual repayment amount will depend
upon how much you borrow, the interest rate when you enter repayment, and the length of your repayment term.
Total Amount of Loans Outstanding:
FFEL (Bank Loans) and/or Direct Loans:
Subsidized Loans:
Unsubsidized Loans:
Combined Loans:
Unallocated Consolidated Loans:
Federal Perkins Loans:
Total Outstanding Principal Balance:
2009-2010 Award Year Loan Amount:
Teach Grants Converted to Direct Loans:
Unsubsidized Loans:

Total Principal
Balance:
$ 100,000
$ N/A
$ N/A
$ N/A

Remaining Amount to be
Disbursed:
$ 50,000
$ N/A
$ N/A

$ N/A
$ N/A
$ 0

$ 0

Information You May Need!
Question 45 on the SAR requires a code. Refer back to this section if necessary.
Codes for Question 45: TYPES OF VETERAN EDUCATION BENEFITS

1 - Montgomery GI Bill - Active Duty (Chapter 30)
2 - Post - 9/11 GI Bill (Chapter 33)
3 - Montgomery GI Bill - Selected Reserve (Chapter 1606)
4 - Reserve Educational Assistance Program (Chapter 1607)
5 - Vocational Rehabilitation and Employment (Chapter 31)
6 - Dependents' Educational Assistance (Chapter 35)
7 - Any Other Type of Veterans Educations Benefits

R5EN000001 999

Total:
$ 150,000
$ N/A
$ N/A
$ N/A

PAGE 4 OF 10

2009 - 2010 STUDENT AID REPORT

OMB No.

Check Your SAR

1845-0008

If you find a mistake put the correct answer in the boxes or completely fill in an oval
(example:
).
Look for arrows (
or
) in the area next to your information. For these items, give us
a new answer, or if your current answer is correct, rewrite the same information exactly.
If you want to delete an answer, draw a line through your answer and through the empty
box or oval (example: 10. Permanent Home Phone Number
).
(301) 555 - 1234

Use your Federal Student Aid PIN to make corrections online at www.fafsa.ed.gov or send in pages 5-10 of this form.

Processed: 03/20/2009

Step One: You (The Student)

1. Last Name
SMITH

2. First Name
JOHN

DRN: 1421

3. Middle Initial
J

4. Permanent Street Address
742 EVERGREEN TERRACE
5. City
SPRINGFILED
8. Social Security Number
555-11-4444

6. State Abbreviation

10. Permanent Home Phone Number
Use MM/DD/YYYY
format (e.g., 03/01/1980) 555-235-1885

9. Date of Birth
/

7. ZIP Code

/ 1 9

11. Driver's License Number
12. Driver's License State Abbreviation
We will use this e-mail address to correspond with you. You will receive your SAR information through a secure link on the internet. We will only share
this address with the colleges you list on the form and your state. Leave blank to receive information through regular mail.
13. Student's E-mail Address
[email protected]
@
14. Citizenship Status
ELIGIBLE NONCITIZEN
15. Alien Registration Number
16. Marital Status
MARRIED/REMARRIED
17. Date of Marital Status

U.S. Citizen

Eligible Noncitizen

Remember to
completely fill in
the oval

Neither

A
Single, Divorced or Widowed

Married/Remarried

Separated

21. Are you male or female?
/
Male
Female
MALE
18. State of Legal Residence Abbreviation Use MM/YYYY format (e.g., 03/1980) 22. If you are male (age 18-25) and
not registered, answer "Register Me"
IL
and Selective Service will register you. Register Me
19. Did you become a legal resident of
REGISTER ME
this state before January 1, 2004
Yes
No
YES
20. If you answered "No" to question 19,
date you became a legal resident
/
R5EN000001 999

PAGE 5 OF 10

You Told Us

You Told Us

23. Drug Conviction Affecting Eligibility? No.............................................
ELIGIBLE FOR AID
Yes (Part-Year)........................
Yes/Don't Know......................
Middle school/Jr. High..........
24. Father's Educational Level
High school.............................
College or beyond................
HIGH SCHOOL
Other/unknown......................
25. Mother's Educational Level
Middle school/Jr. High..........
High school.............................
College or beyond................
COLLEGE OR BEYOND
Other/unknown......................
26. High School Completion Status?
High school diploma..............
GED certificate.........................
Home schooled.......................
HIGH SCHOOL DIPLOMA
None of the above..................
27. First Bachelor's Degree by 7-1-2009? Yes
No
YES
28. Grade Level in College in 2009-2010 1st/Never Attended..................
1st/Previously Attended...........
2nd/Sophomore......................
3RD/JUNIOR
3rd/Junior.................................
4th/Senior.................................
5th or More...............................
1st Yr. Graduate/
Professional..............................
Cont. Graduate/
Professional..............................

Step Two: 2008 Student (and Spouse) Income and Assets

29. Type of Degree/Certificate

30. Enrollment Status in 2009-2010
THREE-QUARTER-TIME
31. What Student Aid Types Interest
You?
BOTH WORK-STUDY AND
STUDENT LOANS

1st Bachelor's degree............
2nd Bachelor's degree.........
Associate degree
(occupational technical
program)................................
Associate degree (general
education or transfer)...........
Certificate or diploma for
completing less than 2 years
Certificate or diploma for
completing at least 2 years
Teaching credential
program..................................
Graduate or professional
degree.....................................
Other/Undecided..................
Full-Time.................................
Three-Quarter-Time..............
Half-Time................................
Less than Half-Time...............
Don't Know............................
Work-Study.............................
Student Loans........................
Both work-study and
student loans........................
Neither...................................
Don't Know............................

32. Planning to complete
coursework to be an elementary or Yes.....................................
secondary school teacher?
No......................................
Don't Know.......................
YES

For 33-47, report your (the student's) income and assets. If you are married as of today, report your and your spouse's income and assets, even if
you were not married in 2008. Ignore references to "spouse" if you are currently single, separated, divorced, or widowed. Remember to completely
fill in the oval as follows:
33. Filed 2008 Income Tax Return
HAVE ALREADY COMPLETED
34. Type of 2008 Tax Form Used
IRS 1040A OR 1040EZ
35. If you filed or will file a 1040, were
you eligible to file a 1040A or 1040EZ?
YES

R5EN000001 999

Have already completed.......
Will file, have not yet
completed.................................
Not going to file........................

For 36-47, if the answer is zero or the question does not apply to you,
enter 0. Report dollar amounts (such as $12,356.00) like this:
EXAMPLE
1 2 , 3 5 6

A. IRS 1040..................................
B. IRS 1040A or 1040EZ..............
C. A foreign tax return.............
D. A tax return with Puerto
Rico, a U.S. Territory or Freely
Associated State.......................

36. Adjusted Gross Income from IRS
Form (IRS Form 1040-line 37; 1040A-line
21; or 1040EZ-line 4.)
$ 355,000
37. U.S. Income Tax Paid from IRS Form
(IRS Form 1040-line 56; 1040A-line 35; or
1040EZ-line 11.)
$ 13,012
38. Exemptions Claimed from IRS Form
(1040-line 6d; 1040A-line 6d; for Form
1040EZ see page 2.)
03

Yes

No

Don't Know

$

PAGE 6 OF 10

$

,
$

,

For 39-40, answer the questions whether or not you filed a tax return. This information may be on your W-2 forms, or
on IRS Form 1040-lines 7+12+18+ Box 14 of IRS Schedule K-1(Form 1065); 1040A-line 7; or 1040EZ-line 1.
39. Student's Income Earned from Work
$
$ 250,000
,
40. Spouse's Income Earned from Work
$
47. Student's Untaxed Income
$ 100,000
,
41. Cash, Savings, and Checking
$
,
a) Tax-deferred pension/savings
42. Net Worth of Investments
$
b) IRA deductions and payments
,
43. Net Worth of Businesses/Investment
$
Farms
,
c) Child support received
44. Will you receive VA education
benefits between 7-1-2009 and 6-30-2010?
Yes
YES
45. What type of VA education benefits
will you receive?
VA CHAPTER 1606

c) Taxable earnings from
need-based employment
d) Student grant and scholarship
aid reported
$ 20,000
e) Special combat pay/combat
pay
$ 4,000

$

$

d) Tax exempt interest income

No

$

e) Untaxed IRA distributions
Enter Code from
Instructions

$

f) Untaxed portions of pensions

46. Student's Additional Financial
Information
a) Education credits
$ 12,000
b) Child support paid

$

$

g) Military or clergy allowances
$

$

$

$

$

$

h) Veterans non education
benefits

,

$

i) Other untaxed income
$ 10,000
j) Money received or paid on
your behalf

,

,

$

$

,

,

,

,

,

,

,

,

,

,

,

,

Step Three: Student Status

For 48 - 60 fill in the oval to enter a new response or correct a response.
48. Born Before 1-1-1986?
No
Yes
YES
49. Are you married?
No
Yes
YES
50. Working on a master's or doctorate
program in 2009-2010?
No
Yes
YES
51. Are you on active duty in U.S. Armed
Forces?
No
Yes
52. Are you a veteran of U.S. Armed
Forces?

Yes

53. Have children who receive more
Yes
than half of their support from you?
NO
54. Have dependents other than children
or spouse?
Yes
YES
R5EN000001 999

No
No
No

55. Are your parents deceased, or were
you (until age 18) a Ward/Dependent Yes
of Court?
56. Are you an emancipated minor?
NO
57. Are you in legal guardianship?
NO
58. Have you been verified as a
homeless child or youth?
NO
59. Has the Department of Housing and
Urban Development determined you to
be homeless?
NO
60. Have you been verified as an
unaccompanied youth who is at risk
for homelessness?
YES

PAGE 7 OF 10

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Step Four: 2008 Parental Information

Complete this section if you (the student) answered "No" to all questions in Step Three. If you do not live with your two parents, then provide information
about the parent you lived with most during the past year (if that parent is married, provide information about the stepmother or stepfather to whom
that parent is married).
61. Parents' Marital Status
62. Date of Marital Status
Married/Remarried
Divorced/Separated
/
WIDOWED
Single........................
Widowed....................
65. First
66. Father's/Stepfather's
63. Your Father's/Stepfather's
64. Your Father's/Stepfather's Last Name
Initial
Date of Birth
Social Security Number
XXX-XX-0123
SMITH
04/21/1923
/

67. Your Mother's/Stepmother's
Social Security Number
XXX-XX-0143

68. Your Mother's/Stepmother's Last Name
SMITH

69. First
Initial

/

70. Mother's/Stepmother's
Date of Birth
04/21/1925
/

/

Provide an email address so
that we can correspond
with your parents.

71. Parents' E-mail Address
[email protected]
@
72. Parents' state of legal residence
IL
73. Parent legal resident of the state
before January 1, 2004?
YES
74. If "No" to question 73, enter the date
parent became legal resident

Yes

76. Parents' number of family members
in college in 2009-2010

82. Filed 2008 Income Tax Return
NOT GOING TO FILE
83. Type of 2008 Tax Form Used
A FOREIGN TAX RETURN

R5EN000001 999

No
/

75. Parents' number of family members
in 2009-2010

77. Parent received Supplemental
Security Income (SSI)?
YES
78. Parent received food stamps?
YES
79. Parent received free/reduced price
lunch?
YES
80. Parent received Temporary
Assistance for Needy Families (TANF)?
YES
81. Parent received Nutrition Program for
Women, Infants and Children (WIC)?

84. If your parents' filed or will file a 1040, Yes......................................
were they eligible to file a 1040A or
No.......................................
1040EZ?
Don't Know........................
85. Are either of your parents a
Yes......................................
dislocated worker?
No.......................................
Don't Know........................
DON'T KNOW

Yes
Yes
Yes
Yes
Yes

Use MM/YYYY format
(e.g. 03/1980)
For 86-95, if the answer is zero or the question does not apply, enter 0.
Report dollar amounts without cents. For 89-90, this information may be
on W-2 forms, or on IRS Form 1040-lines 7+12+18+ Box 14 of IRS Schedule
K-1(Form 1065); 1040A-line 7; or 1040EZ-line 1.
86. Adjusted Gross Income from IRS Form
$
$ 10,000
,
No
87. U.S. Income Tax Paid
$
,
No
88. Exemptions Claimed
03
No
89. Father's/Stepfather's Income
Earned from Work
$
,
No
90. Mother's/Stepmother's Income
Earned from Work
$
,
No
91. Cash, Savings, and Checking

Have already completed
Will file, have not
yet completed..................
Not going to file................
A. IRS 1040..........................
B. IRS 1040A or
1040EZ................................
C. A foreign tax return.....
D. A tax return with Puerto
Rico, a U.S. Territory of
Freely Associated State...

92. Net Worth of Investments
$ 155,000
93. Net Worth of Businesses/Investment
Farms

PAGE 8 OF 10

$

,

$

,

$

,

DRN:1421

94. Parents' Additional Financial
Information
a) Education credits
$ 12,445
b) Child support paid

$

,

$

,

c) Taxable earnings from
need-based employment

$

,

d) Student grant and scholarship
aid reported

$

,

$

,

e) Special combat pay/combat
pay
$ 19,778
95. Parents' Untaxed Income
a) Tax-deferred pension/savings

$

b) IRA deductions and payments
$ 5,000
c) Child support received

,

$

,

$

,

d) Tax exempt interest income
e) Untaxed IRA distributions
$ 2,000
f) Untaxed portions of pensions
g) Military or clergy allowances
$ 3,000
h) Veterans non education
benefits
i) Other untaxed income

$

,

$

,

$

,

$

,

$

,

$

,

Yes

No

Yes

No

Step Five: Student's Household Information
96. Number of Family Members in 2009-2010
5
97. Number in College in 2009-2010
1
98. Student received Supplemental Security
Income?
NO
99. Student received food stamps?
NO
100. Student received free/reduced price
lunch?
NO

Yes

No

Yes

No

Yes

No

Step Six: Student's School Information

101. Student received Temporary Assistance
for Needy Families (TANF)?
NO
102. Student received Nutrition Program for
Women, Infants and Children (WIC)?
NO
103. Are you or your spouse a dislocated
worker?
NO

Housing Plans: 1 --

on campus

2 --

w/Parents

Yes..................
No...................
Don't Know....

3 --

off campus

104.a First College Name, City and State
SALISBURY UNIVERSITY, SALISBURY MD
104.c Second College Name, City and State
UNIVERSITY OF MARYLAND, COLLEGE PARK MD
104.e Third College Name, City and State

104.f Housing Plans

104.g Fourth College Name, City and State

104.h Housing Plans

104.b Housing Plans
OFF CAMPUS
104.d Housing Plans
OFF CAMPUS

Your FAFSA information was sent to all the colleges you listed although they are not all shown here. To see all of the colleges you listed go to
www.fafsa.ed.gov and select “View and Print Your Student Aid Report

R5EN000001 999

PAGE 9 OF 10

Step Seven: Please read, sign and date
105. Date Completed
JANUARY 6, 2009
106. Signed By?
STUDENT
107. Preparer's Social Security Number
REPORTED
108. Preparer's EIN
REPORTED
109. Preparer's Signature
SIGNED

DO NOT CORRECT
DO NOT CORRECT
If this form was filled out by someone other
than you, your spouse, or your parent(s), that
person must complete this part

Application Receipt Date: 1/4/2009

Please read, sign and date. You must read and sign this Certification.

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 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 up to $20,000, sent to prison, or both.
SEND PAGES 5-10 OF THIS FORM TO:

Federal Student Aid Programs
P.O. Box 7004
Mt. Vernon, IL 62864-0074
OR
You may also make corrections from
the Federal Student Aid's web
site (www.fafsa.ed.gov). You must use
your PIN to access your record online.

Student Signature (Required to process your application. Sign in box below.)
1
Student
Date

JOHN SMITH

Parent Signature (one parent whose information is provided in Step Five)
2
Parent
Date

Data Entry Use Only
P

R5EN000001 999

PAGE 10 OF 10Q

*

L

E

Step Seven: Please read, sign and date
105. Date Completed
JANUARY 6, 2009
106. Signed By?
STUDENT
107. Preparer's Social Security Number
REPORTED
108. Preparer's EIN
REPORTED
109. Preparer's Signature
SIGNED

DO NOT CORRECT
DO NOT CORRECT
If this form was filled out by someone other
than you, your spouse, or your parent(s), that
person must complete this part

Application Receipt Date: 1/4/2009

Please read, sign and date. You must read and sign this Certification.

All of the information on this SAR is true and complete to the best of my knowledge. If I am asked, I agree to give proof that my information is correct.
The proof might include a copy of the 2008 U.S. Income Tax Form filed by me or my family. If I sign any document related to the federal student aid
programs electronically using a Federal Student Aid PIN, I certify that I am the person identified by the PIN and have not disclosed that PIN to anyone
else. I understand that if I purposely give false or misleading information on this SAR, I may be subject up to a $20,000 fine, a prison sentence, or both.
If you made no changes:
Do NOT send your SAR to the address given on this page.
Follow the instructions on your SAR. You may need to contact your school.
If you made changes:
You may make corrections from Federal Student Aid's web site (www.fafsa.ed.gov).
You must use your PIN to access your record.
Student Signature (Required to process your application. Sign in box below.)
OR
Student
Date
1
Read the certification statement above and sign to the right.
SEND PAGES 5-10 OF THIS FORM TO:

Federal Student Aid Programs
P.O. Box 7004
Mt. Vernon, IL 62864-0074

JOHN SMITH

Parent Signature (one parent whose information is provided in Step Five)
2
Parent
Date

Data Entry Use Only
P

*

L

If you need another copy of your SAR:
Call the Federal Student Aid Information Center
at 1-800-4-FED-AID (1-800-433-3243)

R5EN000001 999

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