2023-2024 Student Aid Report

2023-2024 Free Application for Federal Student Aid (FAFSA)

1845-0001 2023-24 SAR 30D

2023-2024 Free Application for Federal Student Aid (FAFSA)

OMB: 1845-0001

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1845-0001 can be found here:

2023-09-15 - Revision of a currently approved collection

Document [pdf]

Download: pdf | pdf

STUDENT AID REPORT
2023-2024
HTTPS://FAFSA.GOV
APRIL 22, 2023

OMB No. 1845-0001

000001C001

F 211 2324

DATA RELEASE NUMBER (DRN): 9755
EXPECTED FAMILY CONTRIBUTION (EFC): 000000*C

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JOHN SMITH
742 EVERGREEN TERRACE
SPRINGFIELD OH 55555

Dear

JOHN SMITH,

Your Student Aid Report (SAR) summarizes the information you submitted on your 2023-2024 Free Application for
Federal Student Aid (FAFSA).
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.

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 000000.
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 (free funds that do not have to be repaid), work-study (paid part-time employment), and/or
low-interest loans (borrowed funds that must be repaid). Please note that your EFC is subject to change if you update or
correct your FAFSA.

Your financial aid package could also include other federal, state, or institutional grants and scholarships, and/or a
work-study award. Your school s financial aid office will advise you of the specific types and amounts of student aid you
are eligible to receive. For more information about the EFC, grants, scholarships, work-study, loans and other sources of
aid, go to StudentAid.gov.
) Based on your EFC it appears that you may be eligible for a Federal Pell Grant of up to $6895, provided you have not
met or exceeded the lifetime limit established for the Federal Pell Grant program. You may also be eligible for other
grants, work-study opportunities and low-interest student loans.
) 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!
R5E000001 999

PAGE 1 OF 10

2023-2024 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 such collection displays a valid OMB control number. The valid OMB control number for this
information collection is 1845-0001. Public reporting burden for this collection of information is estimated to average
between five and ten minutes per response, including time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of information. The
obligation to respond to this collection is voluntary. If you have comments or concerns regarding the status of your
individual submission of this form, please contact the Federal Student Aid Information Center, P.O. Box 84,
Washington, D.C. 20044 directly. [Note: Please do not return the completed form to this address.]

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By answering questions 98a through 98h, and signing the 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 2
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 FSA ID with
anyone, including commercial service providers that provide assistance with the financial aid process. You should
keep your FSA ID in a safe location.

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.
D
ABCDEFG
Y
SAR C Flag:
Dependency Status:
Rejects Met:
Y
2A
Application Source:
Dependency Override:
Application Receipt Date: 04/22/2023
Y
2A
Transaction Source:
Professional Judgment:
Transaction Receipt Date: 04/22/2023
Y
Processed Record Type:
Reprocessing Code:
Verification Flag:
1
Duplicate SSN Flag:
Special Circumstances:
IRS Request Flag: Student: 01 Parent: 01
Y
High School Flag:
Verification Selection Change Flag: C
IRS Display Flag: Student: A Parent: C
1
2
3
4
5
6
7
8
9
10
11
12
MONTHS:
PRIMARY EFC:
000000 000000 000000 000000 000000 000000 000000 000000 000000 000000 000000 000000
SECONDARY EFC: 000000 000000 000000 000000 000000 000000 000000 000000 000000 000000 000000 000000
PC:
SIC:
Auto Zero EFC Flag:
Simplified Needs Test Flag:
Pell Eligible Flag:
Y
MATCH FLAGS:
VA Match Flag:
SSN Match Flag:
4
1
NSLDS Results Flag:
DHS Match Flag:
DHS Verification #: 999999999999999
NSLDS Transaction Number: 01
2
NSLDS Match Flag:
DHS Sec. Conf. Flag:
NSLDS Unusual Enrollment History Flag: 1

COMMENTS: 001 115 006
R5E000001 999

PAGE 2 OF 10

SSA Citizenship Code:
P1SSN Match Flag:
P2SSN Match Flag:
CFH Indicator:

C
8
4
Y

2023-2024 STUDENT AID REPORT
COMMENTS ABOUT YOUR INFORMATION

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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 https://fafsa.gov, or by using
this SAR. If you need additional help with your SAR, contact your school's financial aid office or visit https://fafsa.gov and
click the "Help" icon on the FAFSA home page. If your mailing address or e-mail address changes, you can make the
correction online or send in the correction on your SAR.

R5E000001 999

PAGE 3 OF 10

2023-2024 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 loan programs are administered by the U.S. Department of Education (ED). You should confirm
that these loan totals are correct. You can use your FSA ID to view details on the individual loans that make up these
totals at the National Student Loan Data System (NSLDS) Web site at https://studentaid.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.gov Web site.

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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 Federal Family Education Loan (FFEL) Program '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 10-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:
2023-2024 Award Year Loan Amount:
Teach Grants Converted to Direct Loans:
Unsubsidized Loans:

R5E000001 999

Total Principal
Balance:
$ 6,000
$ 3,000
$ N/A
$ N/A

Remaining Amount to be
Disbursed:
$ 1,200
$ 1,300
$ N/A

Total:
$ 7,200
$ 4,300
$ N/A

$ N/A
$ 550

$ 1,612

PAGE 4 OF 10

$ 1,612

2023-2024 STUDENT AID REPORT

OMB No.

Check Your SAR

If you find a mistake, put the correct answer in the boxes or completely fill in an oval (example:

1845-0001

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. Your telephone number
).
(301) 555 - 1234

Make corrections online at https://fafsa.gov or send in pages 5-10 of this form.

DRN: 9755

Step One: You (The Student)

1. Last Name
SMITH

Processed: 04/22/2023

2. First Name
JOHN

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3. Middle Initial
J

4. Mailing Address
742 EVERGREEN TERRACE
5. City
SPRINGFIELD

8. Social Security Number
XXX-XX-4444

6. State Abbreviation
OH

10. Your telephone number
Use MM/DD/YYYY
format (e.g., 03/01/1996) (555) 555-5555

9. Date of Birth
JUNE 13, 1997
/

7. ZIP Code
55555

11. Driver's License Number

12. Driver's License State Abbreviation

We will use your e-mail address to communicate with you electronically. We will also share your e-mail address with your state and the colleges
listed on your FAFSA to allow them to communicate with you. If you do not have an e-mail address, leave this field blank.
13. Student's E-mail Address
[email protected]

14. Citizenship Status

ELIGIBLE NONCITIZEN

15. Alien Registration Number

16. Marital Status (As of the date you
submitted your FAFSA)
MARRIED/REMARRIED

17. Date of Marital Status Change

R5E000001 999

U. S. Citizen................................
Eligible Noncitizen...................
Neither.......................................

Single.........................................
Married/Remarried.................
Separated.................................
Divorced or Widowed.............

/
Use MM/YYYY format (e.g., 03/1996)

PAGE 5 OF 10

Remember to completely fill in the oval as follows:

18. State of Legal Residence Abbreviation
IL
19. Did you become a legal resident of
this state before January 1, 2018?
Yes
No
YES
20. If you answered "No" to question 19,
date you became a legal resident
/
Use MM/YYYY format
(e.g., 03/2012)

You Told Us

HIGH SCHOOL
22. Parent 2 Educational Level
COLLEGE
23. High School Completion Status?

26. Grade Level in College in
2023-2024
3RD

Middle school/Jr. High..........
High school.............................
College or beyond................
Other/unknown......................
High school diploma..............
GED/State Certificate..............
Homeschooled........................
None of the above..................

1st/Never Attended..................
1st/Previously Attended...........
2nd/Sophomore......................
3rd/Junior.................................
4th/Senior.................................
5th/Other Undergraduate.....
1st Yr. Graduate/
Professional..............................
Cont. Graduate/
Professional..............................

27. Type of Degree/Certificate

1st Bachelor's degree............
2nd Bachelor's degree.........
Associate degree
(occupational or 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
(nondegree program)..........
Graduate or professional
degree.....................................
Other/undecided..................

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HS DIPLOMA

Middle school/Jr. High..........
High school.............................
College or beyond................
Other/unknown......................

21. Parent 1 Educational Level

You Told Us

1st BA

24.a High School Name
PRINCE GEORGE'S COUNTY HIGH SCHOOL

24.b High School City
BELTSVILLE

24.c High School State
MD
25. First Bachelor's Degree by 7-1-2023?
YES

Yes

28. Are you interested in being
considered for work-study?
YES

Yes...........................................
No............................................
Don't know.............................

Step Two: 2021 Student (and Spouse) Income and Assets

For 33-41, report your (the student's) income and assets. If you are single, separated, divorced or widowed, answer only about yourself. If you are
married or remarried, as of today, include information about your spouse. Remember to completely fill in the oval as follows:
29. Filed 2021 Income Tax Return?
32. Did (or will) you file a Schedule 1
Already completed.................
Yes....................................
with your 2021 tax return?
Will
file........................................
No.....................................
ALREADY COMPLETED
YES
Don't know.......................
Will not file.................................
30. Type of 2021 Tax Form Used
IRS FORM 1040

31. Tax Return Filing Status 2021

MARRIED-FILED SEPARATE RETURN

R5E000001 999

IRS Form 1040............................
Foreign tax return.....................
U.S. Trust territory.......................

For 33-41, 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:

33. Adjusted Gross Income from IRS
Form 1040--line 11.
$ 1,355,000
34. U.S. Income Tax Paid from IRS Form
1040--line 22 minus Schedule 2--line 2.
$ 1,113,012

EXAMPLE

PAGE 6 OF 10

1 2,3 5 6

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For 35-36, 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--line 1 + Schedule 1--lines 3 + 6 + Schedule K-1 (IRS Form 1065) Box 14 [Code A]. If a tax form line's value is negative, treat it
as a zero in your calculation.
35. Student's Income Earned from Work
$
,
,
$ 1,250,000
36. Spouse's Income Earned from Work
$
$ 1,100,000
,
,
37. Cash, Savings, and Checking (As of
the date you submitted your FAFSA)
41. Student's Untaxed Income
$
,
,
$
38. Net Worth of Investments (As of the
date you submitted your FAFSA)
a) Tax-deferred pensions/savings
$
,
,
$
$
$
,
39. Net Worth of Businesses/Investment
Farms (As of the date you submitted
b) IRA deductions and payments
your FAFSA)
$
,
,
$
,
$
$
c) Child support received
40. Student's Additional Financial
Information
$
$
,
d) Tax-exempt interest income
a) Education credits
$ 12,000
$
$
,
$
,
,
e) Untaxed portions of IRA
b) Child support paid
distributions and pensions
$
,
$
$
,
,
$
f) Military or clergy allowances
c) Taxable earnings from
need-based employment
$
$
,
$
,
,
$
g) Veterans noneducation
d) College grant and scholarship
benefits
aid reported to IRS as income
$
$
,
,
,
$
$ 20,000
h) Other untaxed income
e) Combat pay/special combat
pay
$
,
$
$
,
,
$ 4,000
f) Earnings from work under a
i) Money received or paid on
your behalf
cooperative education program
$
$
,
,
,
$
$

Step Three: Student Dependency Status

Answer questions 42-54 in this step to determine if you will need to provide parental information. Fill in the oval to enter a new response
or correct a response.
42. Born Before 1-1-2000?
49. Were your parents deceased, were
No
Yes
you in foster care or a court
YES
No
Yes
dependent/ward?
43. Are you married (As of the date you
NO
submitted your FAFSA)?
No
Yes
50.
Are/Were
an emancipated minor?
YES
No
Yes
NO
44. Working on a master's or doctorate
program in 2023-2024?
No
Yes
51. Are/Were in legal guardianship?
No
Yes
YES
NO
45. Are you on active duty in U.S. Armed
52. Unaccompanied homeless youth as
Forces?
Yes
No
determined by high school liaison?
Yes
No
NO
46. Are you a veteran of U.S. Armed
53. Unaccompanied homeless youth as
Forces?
Yes
No
determined by HUD?
No
Yes
NO
47. Have children who receive more
than half of their support from you?
54. Unaccompanied homeless youth as
Yes
No
determined by director of homeless
NO
No
Yes
youth center?
48. Have dependents other than children
YES
or spouse?
Yes
No
YES
R5E000001 999

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Step Four (Parental Information): Complete this step if you (the student) answered "No" to all questions in Step Three.
Answer all questions in Step Four even if you do not live with your legal parents (your biological and/or adoptive parents). Grandparents, foster parents,
legal guardians, aunts and uncles are not considered parents on this form unless they have legally adopted you. If your parents are married to each
other, or are not married to each other and live together, answer the questions about both of them. See Notes on page 10 of the FAFSA for information.
56. Date of Marital Status
55. Parents' Marital Status (As of the date Never married...............
Married/Remarried
you submitted your FAFSA)
Divorced/Separated
/
Unmarried and both
WIDOWED
parents living together
Widowed...................
58. Parent 1 Last Name
SMITH

59. First
Initial
B

60. Parent 1 Date of Birth
APRIL 21,1975

57. Parent 1 Social Security Number
XXX-XX-0123

62. Parent 2 Last Name
SMITH

63. First
Initial
T

64. Parent 2 Date of Birth
MARCH 24, 1976

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61. Parent 2 Social Security Number
XXX-XX-0126

65. Parents' E-mail Address
[email protected]

66. Parents' state of legal residence
IL
67. Parent legal resident of the state
before January 1, 2018?
YES
68. If "No" to question 67, enter the date
parent became legal resident

78. Tax Return Filing Status 2021

Yes

MARRIED-FILED SEPARATE RETURN

Use MM/YYYY format 79. Did (or will) your parents file a
(e.g., 03/2011)
Schedule 1 with their 2021 tax return?

69. Parents' number of family members
in 2023-2024

DON'T KNOW

70. Parents' number of family members
in college in 2023-2024

71. Parent received Medicaid or
Supplemental Security Income?
YES
72. Parent received Supplemental
Nutrition Assistance Program (SNAP)?
YES
73. Parent received free or reduced
price school lunch?
YES
74. Parent received Temporary
Assistance for Needy Families (TANF)?
YES
75. Parent received Nutrition Program for
Women, Infants and Children (WIC)?
76. Filed 2021 Income Tax Return?
WILL NOT FILE

77. Type of 2021 Tax Form Used
IRS FORM 1040

R5E000001 999

Yes

Already completed..........
Will file.................................
Will not file..........................

IRS Form 1040.....................
Foreign tax return.............
U.S. Trust territory................

Provide an e-mail address
so that we can correspond
with your parents.

Single........................................
Head of household................
Married-filed joint return........
Married-filed separate return
Qualifying widow(er).............
Don't know...............................
Yes......................................
No.......................................
Don't know........................

80. Are either of your parents a
Yes......................................
dislocated worker (As of the date you
No.......................................
submitted your FAFSA)?
Don't know........................
DON'T KNOW
For 81-89, if the answer is zero or the question does not apply, enter 0.
Report dollar amounts without cents. For 83-84, this information may be on
W-2 forms, or on IRS Form 1040--line 1 + Schedule 1--lines 3 + 6 + Schedule K-1
(IRS Form 1065) Box 14 [Code A]. If a tax form line's value is negative, treat it
as a zero in your calculation.
81. Adjusted Gross Income from IRS
Form 1040--line 11.
$ ,
,
$ 10,000
82. U.S. Income Tax Paid from IRS Form
1040--line 22 minus Schedule 2--line 2.
$ ,
,
$
83. Parent 1 Income Earned from Work
$
$ ,
,
84. Parent 2 Income Earned from Work
$
$ ,
,
85. Cash, Savings, and Checking (As of
the date you submitted your FAFSA)
$ ,
,
$
86. Net Worth of Investments (As of the
date you submitted your FAFSA)
$ ,
,
$ 155,000

PAGE 8 OF 10

DRN: 1421

a) Education credits
$ 12,445
b) Child support
$
c) Taxable earnings from
need-based employment
$
d) College grant and scholarship
aid reported to IRS as income
$
e) Combat pay/special combat
pay
$ 19,778
f) Earnings from work under a
cooperative education program
$ 401

a) Tax-deferred pensions/savings
$
b) IRA deductions and payments
$ 5,000
c) Child support
$
d) Tax-exempt interest income
$
e) Untaxed portions of IRA
distrubutions and pensions
$ 2,000
f) Military or clergy allowances
$ 3,000
g) Veteran's noneducation benefits
$
h) Other untaxed income
$
received

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paid

89. Parents' Untaxed Income

87. Net Worth of Businesses/Investment
Farms (As of the date you submitted
your FAFSA)
$
$
88. Parents' Additional Financial
Information

Step Five: Student's Household Information
90. Number of Family Members in 2023-2024
05
91. Number in College in 2023-2024
1
92. Student received Medicaid or
Supplemental Security Income?
NO
93. Student received Supplemental
Nutrition Assistance Program (SNAP)?
NO
94. Student received free or reduced
price school lunch?
NO

Yes

95. Student received Temporary Assistance
for Needy Families (TANF)?
NO
96. Student received Nutrition Program for
Women, Infants and Children (WIC)?
NO
97. Are you or your spouse a dislocated
worker (As of the date you submitted your
FAFSA)?
NO

Step Six: Student's School Information
98.a First College Name, City and State
NEW BRUNSWICK INSTITUTE OF TECHNOLOGY
PORTLAND, OR
New
New School
School
Name, City,
Code
State

98.b Housing Plans
ON CAMPUS

98.c Second College Name, City and State
UNIVERSITY OF MARYLAND
COLLEGE PARK, MD
New
New School
School
Name, City,
Code
State

98.d Housing Plans
ON CAMPUS

R5E000001 999

PAGE 9 OF 10

Yes

Yes..................
No...................
Don't know....

Housing Plans:

1 -2 -3 --

on campus
w/parents
off campus

98.f Housing Plans
OFF CAMPUS

98.g Fourth College Name, City and State
UNIVERSITY OF TEXAS
AUSTIN, MO
New
New School
School
Name, City,
Code
State

98.h Housing Plans
OFF CAMPUS

Housing Plans:
1 -- on campus
2 -- w/parents
3 -- off campus

98.e Third College Name, City and State
UNIVERSITY OF MISSOURI
ST LOUIS, MO
New
New School
School
Name, City,
Code
State

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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
https://fafsa.gov and select “View or Print your Student Aid Report (SAR)" after logging in.
For the graduation, retention, and transfer rates of the colleges listed on your FAFSA, view your Student Aid Report online at https://fafsa.gov. You can
find these rates and other important consumer information about the colleges you're interested in attending at collegescorecard.ed.gov/.

Step Seven: Certification, Signatures and Date
99. Date Completed
APRIL 22, 2023
100. Signed By?
BOTH
101. Preparer's Social Security Number
XXX-XX-1234
102. Preparer's EIN

DO NOT CORRECT
DO NOT CORRECT

If a fee was paid to someone for advice or for
completing this form, that person must
complete this section.

103. Preparer's Signature

Application Receipt Date: 04/22/2023

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 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. 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 electronically
sign any document related to the federal student aid programs using an FSA ID (username and password) and/or any other credential, you certify
that you are the person identified by that username and password and/or other credential, and have not disclosed that username and password
and/or other credential to anyone else. If you purposely give false Student Signature (Required to process your application. Sign in box below.)
or misleading information, you may be fined up to $20,000, sent to
1
Student
Date
prison, or both.
SEND PAGES 5-10 OF THIS FORM TO:

Federal Student Aid Programs
P.O. Box 7655
London, KY 40742-7655
OR

You may also make corrections from
Federal Student Aid's Web site (https://fafsa.gov).

JOHN SMITH
Parent Signature (one parent whose information is provided in Step Four).
2
Parent
Date

Data Entry Use Only
P

R5E000001 999

PAGE 10 OF 10Q

98.f Housing Plans
OFF CAMPUS

98.g Fourth College Name, City and State
UNIVERSITY OF TEXAS
AUSTIN, MO
New
New School
School
Name, City,
Code
State

98.h Housing Plans
OFF CAMPUS

Housing Plans:
1 -- on campus
2 -- w/parents
3 -- off campus

98.e Third College Name, City and State
UNIVERSITY OF MISSOURI
ST LOUIS, MO
New
New School
School
Name, City,
Code
State

D
R
SA A
F
M T
PL D
E AT
D E
AT : 0
A 5/1
2/
20

Step Seven: Certification, Signatures and Date
99. Date Completed
APRIL 22, 2023
100. Signed By?
BOTH
101. Preparer's Social Security Number
XXX-XX-1234
102. Preparer's EIN

DO NOT CORRECT
DO NOT CORRECT

If a fee was paid to someone for advice or for
completing this form, that person must
complete this section.

103. Preparer's Signature

Application Receipt Date: 04/22/2023

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 2021 U.S. Income Tax Form filed by me or my family. I understand that if I purposely give false or misleading
information on this SAR, I may be fined up to $20,000, sent to prison, 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
(https://fafsa.gov).
Student Signature (Required to process your application. Sign in box below.)
1
Student
Date
OR
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 7655
London, KY 40742-7655

JOHN SMITH
Parent Signature (one parent whose information is provided in Step Four).
2
Parent
Date

Data Entry Use Only
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)
R5E000001 999

P
PAGE 10 OF 10V

98.f Housing Plans
OFF CAMPUS

98.g Fourth College Name, City and State
UNIVERSITY OF TEXAS
AUSTIN, MO
New
New School
School
Name, City,
Code
State

98.h Housing Plans
OFF CAMPUS

Housing Plans:
1 -- on campus
2 -- w/parents
3 -- off campus

98.e Third College Name, City and State
UNIVERSITY OF MISSOURI
ST LOUIS, MO
New
New School
School
Name, City,
Code
State

D
R
SA A
F
M T
PL D
E AT
D E
AT : 0
A 5/1
2/
20

Step Seven: Certification, Signatures and Date
99. Date Completed
APRIL 22, 2023
100. Signed By?
BOTH
101. Preparer's Social Security Number
XXX-XX-1234
102. Preparer's EIN

DO NOT CORRECT
DO NOT CORRECT

If a fee was paid to someone for advice or for
completing this form, that person must
complete this section.

103. Preparer's Signature

Application Receipt Date: 04/22/2023

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

Federal Student Aid Programs
P.O. Box 7657
London, KY 40742-7657
OR

You may also make corrections from
Federal Student Aid's Web site (https://fafsa.gov).

JOHN SMITH
Parent Signature (one parent whose information is provided in Step Four).
2
Parent
Date

Data Entry Use Only
P

R5E000001 999

PAGE 10 OF 10Q

98.f Housing Plans
OFF CAMPUS

98.g Fourth College Name, City and State
UNIVERSITY OF TEXAS
AUSTIN, MO
New
New School
School
Name, City,
Code
State

98.h Housing Plans
OFF CAMPUS

Housing Plans:
1 -- on campus
2 -- w/parents
3 -- off campus

98.e Third College Name, City and State
UNIVERSITY OF MISSOURI
ST LOUIS, MO
New
New School
School
Name, City,
Code
State

D
R
SA A
F
M T
PL D
E AT
D E
AT : 0
A 5/1
2/
20

Step Seven: Certification, Signatures and Date
99. Date Completed
APRIL 22, 2023
100. Signed By?
BOTH
101. Preparer's Social Security Number
XXX-XX-1234
102. Preparer's EIN

DO NOT CORRECT
DO NOT CORRECT

If a fee was paid to someone for advice or for
completing this form, that person must
complete this section.

103. Preparer's Signature

Application Receipt Date: 04/22/2023

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

SEND PAGES 5-10 OF THIS FORM TO:

Federal Student Aid Programs
P.O. Box 7657
London, KY 40742-7657

JOHN SMITH
Parent Signature (one parent whose information is provided in Step Four).
2
Parent
Date

Data Entry Use Only
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)
R5E000001 999

P
PAGE 10 OF 10V

File Type	application/pdf
File Modified	2022-05-24
File Created	2021-08-20