APPENDIX G

Sample ISIR

2003-2004 Institutional Student Information Record

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\* IMPORTANT: Read ALL information to find out what to do with this
Report. \*

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OMB Number: 1845-0008

WILLIAM O\'BRIEN AUGUST 19, 2003

1123 WEST L

IOWA CITY IA 52240 EFC 0

006

If you need additional help with your ISIR, contact your school
Financial Aid

Administrator (FAA) or the Federal Student Aid Information Center at
1-800-4-FED-AID

(1-800-433-3243). If your address changes, contact your school or call
1-800-4-FED-AID and ask a customer service representative to make the
change for you.

149

Based on the information we have on record for you, your EFC is 0. Your
school will use

this number to determine what types of aid and how much you are eligible
for. You may be

eligible to receive a Federal Pell Grant and other federal student aid.

143

Your citizenship status has been confirmed by the Immigration and
Naturalization Service

(INS) and you meet the citizenship requirements for federal student aid.

Page 1 of 5 444-22-4444 O\' 05

2003-2004 Institutional Student Information Record

Student ID 444-22-4444 O\' 05 EFC 0

STEP ONE (THE STUDENT) (Q1 - Q35) Dependency Status D

Name WILLIAM O\'BRIEN

Address: 1123 WEST L

IOWA CITY IA 90019

Social Security Number 444-22-4444 Cash, Savings, and Checking 0

Date of Birth 02/25/1970 No. of Months VA Benefits Received 0

Permanent Home Phone \# (319)555-5555 hMonthly VA Educational Benefits 0

E-mail Address FWILLIAM_LO\'BRIEN@electricu.edu

Driver\'s License \# C6733206-CA STEP THREE (THE STUDENT) (Q52 - Q58)

Citizenship Status Born Before 1-1-1980? YES

Alien Registration Number A071111111 hMaster\'s/Doctorate Prog. in
2003-2004? NO

Marital Status UNMARRIED hIs Student Married? NO

Marital Status Date 02/1970 hHave Children You Support? NO

Enroll Plan Summer 2003 NOT ATTENDING hDependents Other Than
Children/Spouse? NO

Enroll Plan Fall 2003 Orphan or Ward of the Court? NO

Enroll Plan Wint 2003-4 FULL TIME/NOT SURE Veteran of U.S. Armed Forces?
NO

Enroll Plan Spring 2004 FULL TIME/NOT SURE

Enroll Plan Summer 2004 FULL TIME/NOT SURE STEP FOUR (PARENTS) (Q59 -
Q84)

Father\'s Educational Level \*Marital Status SINGLE

Mother\'s Educational Level Marital Status Date 02/1950

State of Legal Residence CA Father\'s/Stepfather\'s SSN 444-22-0000

Legal Resident before 1-1-1998? YES Father\'s Last Name O\'BRIEN

Legal Residence Date 06/1991 Mother\'s/Stepmother\'s SSN 444-22-1111

Are You Male? YES Mother\'s Last Name O\'BRIEN

Register for Selective Service? Number of Family Members

Degree/Certificate TEACHING Number in College in 2003-2004

Grade Level in College 2nd YR/SOPH State of Legal Residence

HS Diploma or GED Received? NO Legal Residents before 1-1-1998?

First Bachelor\'s Degree by 7-1-2003? NO Legal Residence Date

Interested in Student Loans? NO Age of Older Parent

Interested in Student Employment? YES hTax Return Filed? WILL FILE

Drug Conv Affecting Elig? NO Type of 2002 Tax Return Used FOREIGN

Eligible to File 1040A or 1040EZ?

STEP TWO (STUDENT & SPOUSE) (Q36 - Q51) Adjusted Gross Income

Tax Return Filed? WILL FILE U.S. Income Tax Paid

Type of 2002 Tax Return Used 1040 Exemptions Claimed

Eligible to File 1040A or 1040EZ? Father\'s Inc Earned From Work

Adjusted Gross Income 16370 Mother\'s Inc Earned From Work

U.S. Income Tax Paid 0 Total from Worksheet A 0

Exemptions Claimed 01 Total from Worksheet B

Student\'s Inc Earned From Work 0 Total from Worksheet C

Spouse\'s Inc Earned From Work 0 Net Worth of Investments 0

Total from Worksheet A 0 Net Worth of Business/Farm 0

Total from Worksheet B 0 Cash, Savings, and Checking 0

Total from Worksheet C 0

Net Worth of Investments 0 STEP FIVE (STUDENT HH) (Q85 - Q86)

hNet Worth of Business/Farm 0 Number Family Members 01

Number in College in 2003-2004 1

\*=assumption h=highlight flag #=corrected this trans @=corrected
previous trans

Page 2 of 5

2003-2004 Institutional Student Information Record

Student ID 444-22-4444 O\' 05 EFC 0

Last Name O\'BRIEN

STEP SIX (Q87 - Q98)

School #1 001224 Housing #1 ON CAMPUS

School #2 031089 Housing #2 ON CAMPUS

School #3 015090 Housing #3 ON CAMPUS

School #4 000000 Housing #4 ON CAMPUS OFFICE INFORMATION

School #5 000000 Housing #5 ON CAMPUS DRN 0000

School #6 003051 Housing #6 ON CAMPUS Primary EFC Type 1

Secondary EFC Type

STEP SEVEN (Q100 - Q104) Processed Date 08/19/2003

Date Application Completed 02/25/2003 Application Data Source FAFSA WEB

Signed By APPLICANT ISIR Transaction Type AUTOMATIC ISIR

Preparer\'s SSN Source of Correction

Preparer\'s EIN Federal School Code Indicator 015090

Preparer\'s Signature Reject Override Codes:

A: B: C:1 N: W:

Assumption Override Codes:

1: 2: 3: 4: 5: 6:

\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\--

FAA Information Early Analysis Flag

Date ISIR Received 08/26/2002 Rejects Met:

Verification Flag N Verification Tracking Flag

System Generated Indicator Dependency Override

FAA Adjustment Duplicate Request

Transaction Receipt Date 08/19/2003 Correction \# Applied To

Reprocessing Code Application Receipt Date 03/04/2003

Processed Record Type Input Record Type

Paid EFC Type PRIMARY Pell Elig Flag Y Intermediate Values

Primary EFC 0 Secondary EFC TI 214640 PCA

Mon 1 Mon 7 Mon 1 Mon 7 ATI AAI

Mon 2 Mon 8 Mon 2 Mon 8 STX TSC

Mon 3 Mon 10 Mon 3 Mon 10 EA TPC

Mon 4 Mon 11 Mon 4 Mon 11 IPA PC 0

Mon 5 Mon 12 Mon 5 Mon 12 AI STI 0

Mon 6 Mon 6 CAI SATI 0

DNW SIC

NW 0 SDNW 0

APA SCA

FTI 0

Auto Zero EFC Flag Y Duplicate SSN Flag

EFC Change Flag NO CHANGE Subsequent App Flag

SNT Flag NO

Match Flags: SSN 4 SSA INS SS Y NSLDS 1 VA INS Sec. Conf.

INS Ver. No. SS Registration Flag

NSLDS Transaction Number 5 NSLDS Database Results Flag 1

Comments: 006,149,143

\*=assumption h=highlight flag #=corrected this trans @=corrected
previous trans

Page 3 of 5

2003-2004 Institutional Student Information Record

WILLIAM O\'BRIEN

444-22-4444

2003-2004 NSLDS FINANCIAL AID HISTORY Processed: 08/19/2003

This page contains your previous financial aid information, which is
contained in the

National Student Loan Data System (NSLDS). Your Financial Aid
Administrator will use

it to determine your eligibility.

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#Overpayment: Contact: Discharged Defaulted Loan Sat. Active Post
Screening

Loan Flag: Loans: Repayment: Bankruptcy:N Reason:

Pell: N

FSEOG: N

Perkins:

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Aggregate Amounts: Outstanding Pending Total:

FFEL/Direct Loans: Prin. Bal.: Disb(s):

Subsidized Loans: \$ 11,103 \$ 0 \$ 11,103

Unsubsidized Loans: \$ \$ 0 \$ 1

Combined Loans: \$ \$ 1 \$ 11,104

FFEL Consol. Loans: \$ 0 \$ 0

Perkins Loans:

Outstanding Principal Bal.: \$ 0 Current Year Loan Amount: \$ 0

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#Pell Payment Data:

Sch.Code: 00305100 Tran: 05 Sch.Amt:\$2,800 Award Amt:\$2,800
Disb.Amt:\$ 700

%Sch.Used: 25.00 As Of: 08/19/2003 Pell Verification Flag: EFC: 0

Sch.Code: Tran: Sch.Amt: Award Amt: Disb.Amt:

%Sch.Used: As Of: Pell Verification Flag: EFC:

Sch.Code: Tran: Sch.Amt: Award Amt: Disb.Amt:

%Sch.Used: As Of: Pell Verification Flag: EFC:

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Loan Detail: Net Loan Begin End GA School Grade Contact

Amount Date Date Code Code Level Code/Type

Additional Loan Capitalized Date of Amt of

Unsub Type Interest Last Disb Last Disb

FFEL Stafford Subsidized \$ 1,564 08/16/1994 05/26/1995 706 00119700 ABC
SCHCONTC/386

Neither Recent NO 08/16/1994 \$1564

Status Code RP as of 02/01/1997

Outstanding Bal. \$1,564 as of 12/31/1995

MPN Information

Direct Loan Subsidized/Unsubsidized MPN: No MPN on File

Direct Loan PLUS MPN: No MPN on File

Page 4 of 5 444-22-4444 O\' 05

2003-2004 Institutional Student Information Record

Student ID 444-22-4444 O\' 05 EFC 0

Last Name O\'BRIEN

READ, SIGN, AND DATE

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, and (4) will

notify your school if you default on a federal student loan.

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 your U.S. or state income tax forms. 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 purposely give false or misleading information, you may
be fined

\$20,000, sent to prison, or both.

Everyone whose information is given on this form should sign below. The
student (and

at least one parent, if parent information is given) MUST sign below.

Student
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Parent
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Page 5 of 5