**APPENDIX C**

EZ FAFSA Prototype

+---------+------------------------+----------------------------------+
| !       | *[EZ                   | July 1, 2005-June 30, 2006       |
| [](medi | FAFSA]{.underline}*    |                                  |
| a/image |                        |                                  |
| 1.png){ | *We help put America   |                                  |
| width=" | through school*        |                                  |
| 0.72708 |                        |                                  |
| 3333333 |                        |                                  |
| 3333in" |                        |                                  |
| he      |                        |                                  |
| ight="0 |                        |                                  |
| .627777 |                        |                                  |
| 7777777 |                        |                                  |
| 778in"} |                        |                                  |
+---------+------------------------+----------------------------------+
|         |                        | ***Free Application for Federal  |
|         |                        | Student Aid***                   |
+---------+------------------------+----------------------------------+
|         |                        |                                  |
+---------+------------------------+----------------------------------+

Step One: For questions 1-16, leave blank any question that does not
apply to you (the student)

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<col style="width: 2%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="20"><strong>1.</strong> Name <em>(Last)</em></td>
<td colspan="6">F</td>
<td colspan="8">O</td>
<td colspan="8">R</td>
<td colspan="11"></td>
<td colspan="9">I</td>
<td colspan="9">N</td>
<td colspan="7">F</td>
<td colspan="11">O</td>
<td colspan="10">R</td>
<td colspan="7">M</td>
<td colspan="8">A</td>
<td colspan="12">T</td>
<td colspan="8">I</td>
<td colspan="10">O</td>
<td colspan="12">N</td>
<td colspan="29"><em>First</em></td>
<td colspan="8">D</td>
<td colspan="8">O</td>
<td colspan="9"></td>
<td colspan="9">N</td>
<td colspan="8">O</td>
<td colspan="10">T</td>
<td colspan="9"></td>
<td colspan="7">S</td>
<td colspan="9">U</td>
<td colspan="13">B</td>
<td colspan="14">M</td>
<td colspan="9">I</td>
<td colspan="10">T</td>
<td colspan="14"></td>
<td colspan="10"></td>
<td colspan="23"><em>MI</em></td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td colspan="42"><strong>2.</strong> Social Security Number</td>
<td colspan="14"></td>
<td colspan="11"></td>
<td colspan="12"></td>
<td colspan="12"><strong>-</strong></td>
<td colspan="12"></td>
<td colspan="13"></td>
<td colspan="15"><strong>-</strong></td>
<td colspan="12"></td>
<td colspan="19"></td>
<td colspan="12"></td>
<td colspan="14"></td>
<td colspan="52"><strong>3.</strong> Date of Birth</td>
<td colspan="11"><strong>M</strong></td>
<td colspan="13"><strong>M</strong></td>
<td colspan="19"><strong>D</strong></td>
<td colspan="17"><strong>D</strong></td>
<td colspan="17"><strong>Y</strong></td>
<td colspan="16"><strong>Y</strong></td>
<td colspan="14"><strong>Y</strong></td>
<td colspan="11"><strong>Y</strong></td>
</tr>
<tr class="odd">
<td colspan="24"><strong>4.</strong> Address <em>(Street)</em></td>
<td colspan="9"></td>
<td colspan="7"></td>
<td colspan="12"></td>
<td colspan="9"></td>
<td colspan="8"></td>
<td colspan="8"></td>
<td colspan="11"></td>
<td colspan="8"></td>
<td colspan="9"></td>
<td colspan="8"></td>
<td colspan="12"></td>
<td colspan="8"></td>
<td colspan="12"></td>
<td colspan="12"></td>
<td colspan="10"></td>
<td colspan="10"></td>
<td colspan="12"></td>
<td colspan="6"></td>
<td colspan="9"></td>
<td colspan="9"></td>
<td colspan="8"></td>
<td colspan="8"></td>
<td colspan="10"></td>
<td colspan="9"></td>
<td colspan="6"></td>
<td colspan="9"></td>
<td colspan="13"></td>
<td colspan="14"></td>
<td colspan="10"></td>
<td colspan="9"></td>
<td colspan="14"></td>
<td colspan="10"></td>
<td colspan="10"></td>
<td colspan="14"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="24"><em>City</em></td>
<td colspan="8"></td>
<td colspan="7"></td>
<td colspan="10"></td>
<td colspan="11"></td>
<td colspan="8"></td>
<td colspan="8"></td>
<td colspan="10"></td>
<td colspan="8"></td>
<td colspan="11"></td>
<td colspan="10"></td>
<td colspan="12"></td>
<td colspan="10"></td>
<td colspan="12"></td>
<td colspan="15"></td>
<td colspan="9"></td>
<td colspan="8"></td>
<td colspan="41"><em>State</em></td>
<td colspan="9"></td>
<td colspan="11"></td>
<td colspan="54"><em>Zip Code</em></td>
<td colspan="13"></td>
<td colspan="16"></td>
<td colspan="12"></td>
<td colspan="13"></td>
<td colspan="8"></td>
</tr>
<tr class="odd">
<td colspan="81"><strong>5.</strong> Telephone Number <strong>(MS &amp;
NH Only)</strong></td>
<td colspan="9"></td>
<td colspan="7"></td>
<td colspan="7"></td>
<td colspan="7"><strong>-</strong></td>
<td colspan="11"></td>
<td colspan="9"></td>
<td colspan="7"></td>
<td colspan="10"><strong>-</strong></td>
<td colspan="12"></td>
<td colspan="9"></td>
<td colspan="9"></td>
<td colspan="8"></td>
<td colspan="172"></td>
</tr>
<tr class="even">
<td colspan="87"><strong>6.</strong> Driver’s License Information
<em>(Number)</em></td>
<td colspan="11"></td>
<td colspan="9"></td>
<td colspan="10"></td>
<td colspan="12"></td>
<td colspan="11"></td>
<td colspan="12"></td>
<td colspan="14"></td>
<td colspan="9"></td>
<td colspan="15"></td>
<td colspan="7"></td>
<td colspan="9"></td>
<td colspan="10"></td>
<td colspan="8"></td>
<td colspan="8"></td>
<td colspan="12"></td>
<td colspan="9"></td>
<td colspan="12"></td>
<td colspan="15"></td>
<td colspan="13"></td>
<td colspan="12"></td>
<td colspan="36"><em>State</em></td>
<td colspan="13"></td>
<td colspan="4"></td>
</tr>
<tr class="odd">
<td colspan="25"><strong>7.</strong> Email Address</td>
<td colspan="6"></td>
<td colspan="7"></td>
<td colspan="9"></td>
<td colspan="11"></td>
<td colspan="8"></td>
<td colspan="14"></td>
<td colspan="12"></td>
<td colspan="8"></td>
<td colspan="9"></td>
<td colspan="10"></td>
<td colspan="11"></td>
<td colspan="16"></td>
<td colspan="8"></td>
<td colspan="17"></td>
<td colspan="12"></td>
<td colspan="19">@</td>
<td colspan="10"></td>
<td colspan="8"></td>
<td colspan="8"></td>
<td colspan="6"></td>
<td colspan="11"></td>
<td colspan="10"></td>
<td colspan="15"></td>
<td colspan="14"></td>
<td colspan="15"></td>
<td colspan="17"></td>
<td colspan="12"></td>
<td colspan="11"></td>
<td colspan="10"></td>
<td colspan="9"></td>
</tr>
<tr class="even">
<td colspan="130" rowspan="2"><p><strong>8.</strong> Are you a US
Citizen? <strong>(See page 2)</strong></p>
<p>⁫ Yes (Skip to question 9)</p>
<p>⁫ No, but am an eligible noncitizen (Fill in Alien Registration
Number)</p>
<p>⁫ No and am not an eligible noncitizen</p></td>
<td colspan="98">Alien Registration Number</td>
<td colspan="130" rowspan="2"><p><strong>9.</strong> What is your
marital status as of today? <strong>(NY Only)</strong></p>
<p>⁫ I am married/remarried</p>
<p>⁫ I am separated</p>
<p>⁫ I am single, divorced, or widowed</p></td>
</tr>
<tr class="odd">
<td colspan="12"><strong>A</strong></td>
<td colspan="11"></td>
<td colspan="12"></td>
<td colspan="11"></td>
<td colspan="16"></td>
<td colspan="6"></td>
<td colspan="7"></td>
<td colspan="9"></td>
<td colspan="7"></td>
<td colspan="7"></td>
</tr>
<tr class="even">
<td colspan="259"><strong>10.</strong> Month and year you were married,
separated, divorced, or widowed</td>
<td colspan="19">M</td>
<td colspan="17">M</td>
<td colspan="17">Y</td>
<td colspan="19">Y</td>
<td colspan="14">Y</td>
<td colspan="13">Y</td>
</tr>
<tr class="odd">
<td colspan="36"><strong>11.</strong> State Residency</td>
<td colspan="12" rowspan="2"></td>
<td colspan="16" rowspan="2"></td>
<td colspan="111" rowspan="2"><p><em>Did you become a legal resident of
this state before January 1, 2000?</em></p>
<p>⁫ Yes ⁫ No</p></td>
<td colspan="84" rowspan="2"><em>If the answer is no, give month and
year you became a legal resident</em></td>
<td colspan="19" rowspan="2">M</td>
<td colspan="17" rowspan="2">M</td>
<td colspan="17" rowspan="2">Y</td>
<td colspan="19" rowspan="2">Y</td>
<td colspan="14" rowspan="2">Y</td>
<td colspan="13" rowspan="2">Y</td>
</tr>
<tr class="even">
<td colspan="36"><em>What is your state of legal residence?</em></td>
</tr>
<tr class="odd">
<td colspan="230"><strong>12.</strong> What degree or certificate will
you be working on during 2005-06? <strong>(See page 2)</strong></td>
<td colspan="36"></td>
<td colspan="92" rowspan="2"></td>
</tr>
<tr class="even">
<td colspan="230"><strong>13.</strong> What will be your grade level
when you begin the 2005-06 school year? <strong>(See page
2)</strong></td>
<td colspan="36"></td>
</tr>
<tr class="odd">
<td colspan="266"><strong>14.</strong> Will you have a high school
diploma or GED before you begin the 2005-06 school year? <strong>(TN
Only)</strong></td>
<td colspan="49">⁫ Yes</td>
<td colspan="43">⁫ No</td>
</tr>
<tr class="even">
<td colspan="266"><strong>15.</strong> Will you have your first
bachelor’s degree before July 1, 2005?</td>
<td colspan="49"><strong>⁫</strong> Yes</td>
<td colspan="43"><strong>⁫</strong> No</td>
</tr>
<tr class="odd">
<td colspan="358"><strong>16.</strong> Highest school your Parents
completed? <strong>(See page 2) (CA &amp; MS Only)</strong></td>
</tr>
<tr class="even">
<td colspan="51"><em>Father:</em></td>
<td colspan="90">⁫ Middle School/Junior High</td>
<td colspan="74">⁫ High School</td>
<td colspan="76">⁫ College or beyond</td>
<td colspan="67">⁫ Other/ Unknown</td>
</tr>
<tr class="odd">
<td colspan="50"><em>Mother:</em></td>
<td colspan="91">⁫ Middle School/Junior High</td>
<td colspan="74">⁫ High School</td>
<td colspan="76">⁫ College or beyond</td>
<td colspan="67">⁫ Other/ Unknown</td>
</tr>
<tr class="even">
<td colspan="358"><strong>Step Two: Answer all seven questions in this
step.</strong></td>
</tr>
<tr class="odd">
<td colspan="270"><strong>17.</strong> Were you born before January 1,
1982?</td>
<td colspan="88">⁫ Yes ⁫ No</td>
</tr>
<tr class="even">
<td colspan="270"><strong>18.</strong> At the beginning of 2005-06
school year, will you be working on a master’s or doctorate program
(such as an MA, MBA, MD, JD, PhD, EdD, or graduate certificate,
etc.)?</td>
<td colspan="88">⁫ Yes ⁫ No</td>
</tr>
<tr class="odd">
<td colspan="270"><strong>19.</strong> As of today, are you married?
(Answer “Yes” if you are separated but not divorced.)</td>
<td colspan="88">⁫ Yes ⁫ No</td>
</tr>
<tr class="even">
<td colspan="270"><strong>20.</strong> Do you have children who receive
more than half of their support from you?</td>
<td colspan="88">⁫ Yes ⁫ No</td>
</tr>
<tr class="odd">
<td colspan="270"><strong>21.</strong> Do you have dependents (other
than your children or spouse) who live with you and who receive more
than half of their support from you, now and through June 30, 2006?</td>
<td colspan="88">⁫ Yes ⁫ No</td>
</tr>
<tr class="even">
<td colspan="270"><strong>22.</strong> Are both of your parents
deceased, or are you (or were you until age 18) a ward/dependent of the
court?</td>
<td colspan="88">⁫ Yes ⁫ No</td>
</tr>
<tr class="odd">
<td colspan="270"><strong>23.</strong> Are you a veteran of the U.S.
Armed Forces? <strong>(See page 2)</strong></td>
<td colspan="88">⁫ Yes ⁫ No</td>
</tr>
<tr class="even">
<td colspan="358"><strong>If you (the student) answer “No” to every
question in Step Two, skip Step Three and go to Step Four. If you answer
“Yes” to any question in Step Two, go to Step Three and skip Step Four.
Health profession students</strong>: Your school may require you to
complete Step Four even if you answered “Yes” to any part of Step
Two</td>
</tr>
<tr class="odd">
<td colspan="358"><strong>Step Three: For questions 24-30, report your
(the student’s) income. If you are married as of today, report your and
your spouse’s income, even if you were not married in 2004. Ignore
references to “spouse” if you are currently single, separated, divorced,
or widowed.</strong></td>
</tr>
<tr class="even">
<td colspan="120"><strong>24.</strong> For 2004, have you (the student)
completed your IRS income tax return or another tax return listed in
question 25?</td>
<td colspan="89">⁫ I have already completed my return.</td>
<td colspan="69">⁫ I will file, but I have not yet completed my
return.</td>
<td colspan="80">⁫ I’m not going to file. <strong>(Skip to question
30)</strong></td>
</tr>
<tr class="odd">
<td colspan="41"><strong>25.</strong> What income tax return did you
file or will you file for 2004?</td>
<td colspan="31">⁫ IRS 1040</td>
<td colspan="51">⁫ IRS 1040A, 1040EZ, 1040 Telefile</td>
<td colspan="61">⁫ A foreign tax return <strong>(See page
2)</strong></td>
<td colspan="174">⁫ A tax return for: Puerto Rico, Guam, American Samoa,
the US Virgin Islands, the Marshall Islands, the Federated States of
Micronesia, or Palau <strong>(See page 2)</strong></td>
</tr>
<tr class="even">
<td colspan="267"><strong>26.</strong> If you have filed or will file a
1040, were you eligible to file a 1040A or 1040EZ? <strong>(See page
2)</strong></td>
<td colspan="47">⁫ Yes</td>
<td colspan="44">⁫ No</td>
</tr>
<tr class="odd">
<td colspan="267"><strong>27.</strong> In the past 24 months have you
participated in a federal means-tested program? <strong>(See page
2)</strong></td>
<td colspan="47">⁫ Yes</td>
<td colspan="44">⁫ No</td>
</tr>
<tr class="even">
<td colspan="269"><strong>28.</strong> What was your (and spouse’s)
adjusted gross income for 2004? Found on IRS Form 1040-line 34;
1040A-line21; 1040EZ-line 4; or Telefile-line 1.</td>
<td colspan="16">$</td>
<td colspan="10"></td>
<td colspan="12"></td>
<td colspan="14"></td>
<td colspan="10">,</td>
<td colspan="11"></td>
<td colspan="11"></td>
<td colspan="5"></td>
</tr>
<tr class="odd">
<td colspan="269"><strong>29.</strong> Enter your (and spouse’s) income
tax for 2004. Found on IRS Form 1040-line54; 1040A-line 36; 1040EZ-line
10; or Telefile-Line K (2)</td>
<td colspan="16">$</td>
<td colspan="10"></td>
<td colspan="12"></td>
<td colspan="14"></td>
<td colspan="10">,</td>
<td colspan="11"></td>
<td colspan="11"></td>
<td colspan="5"></td>
</tr>
<tr class="even">
<td colspan="235" rowspan="2"><strong>30.</strong> How much did you (and
spouse) earn from working (wages, salaries, tips, etc) in 2004? Answer
this question whether or not you filed a tax return. This information
may be on your W-2 forms, on IRS Form 1040-lines 7+12+18; 1040A-line 7;
or 1040EZ-line 1. Telefilers use W-2 forms.</td>
<td colspan="34">You</td>
<td colspan="16">$</td>
<td colspan="10"></td>
<td colspan="12"></td>
<td colspan="14"></td>
<td colspan="9">,</td>
<td colspan="12"></td>
<td colspan="11"></td>
<td colspan="5"></td>
</tr>
<tr class="odd">
<td colspan="34">Spouse</td>
<td colspan="16">$</td>
<td colspan="10"></td>
<td colspan="12"></td>
<td colspan="14"></td>
<td colspan="9">,</td>
<td colspan="12"></td>
<td colspan="11"></td>
<td colspan="5"></td>
</tr>
<tr class="even">
<td colspan="358"><strong>Page 3</strong> For
Help-www.studentaid.ed.gov/completefafsa</td>
</tr>
<tr class="odd">
<td colspan="358">Step Four: Complete this step if you (the student)
answered “No” to all questions in Step Two. Go to page 2 to determine
who is a parent for this step.</td>
</tr>
<tr class="even">
<td colspan="358"><strong>31.</strong> What is your parent’s marital
status as of today? ⁫ Married/Remarried ⁫ Divorced/Separated ⁫ Single ⁫
Widowed</td>
</tr>
<tr class="odd">
<td colspan="43"><strong>32.</strong> State Residency</td>
<td colspan="11" rowspan="2"></td>
<td colspan="9" rowspan="2"></td>
<td colspan="98" rowspan="2"><em>Did your parents become legal residents
of this state before January 1, 1999?</em> ⁫ Yes ⁫ No</td>
<td colspan="124" rowspan="2"><em>If the answer is “No,” give month and
year legal residency began for the parent who lived in the state the
longest</em></td>
<td colspan="12" rowspan="2">M</td>
<td colspan="14" rowspan="2">M</td>
<td colspan="15" rowspan="2">Y</td>
<td colspan="12" rowspan="2">Y</td>
<td colspan="13" rowspan="2">Y</td>
<td colspan="7" rowspan="2">Y</td>
</tr>
<tr class="even">
<td colspan="43"><p><em>What is your parents’</em></p>
<p><em>state of legal residence?</em></p></td>
</tr>
<tr class="odd">
<td colspan="358"><strong>33.</strong> What are the Social Security
Numbers, names, and dates of birth of the parents reporting information
on this form? If your parent does not have a Social Security Number, you
must enter 000-00-0000.</td>
</tr>
<tr class="even">
<td colspan="74">Father’s/Stepfather’s Social Security Number</td>
<td colspan="161">Father’s/Stepfather’s Last name, and First
Initial</td>
<td colspan="123">Father’s/Stepfather’s Date of Birth</td>
</tr>
<tr class="odd">
<td></td>
<td colspan="5"></td>
<td colspan="4"></td>
<td colspan="3">-</td>
<td colspan="4"></td>
<td colspan="6"></td>
<td colspan="12">-</td>
<td colspan="8"></td>
<td colspan="12"></td>
<td colspan="10"></td>
<td colspan="10"></td>
<td colspan="10"></td>
<td colspan="8"></td>
<td colspan="7"></td>
<td colspan="8"></td>
<td colspan="10"></td>
<td colspan="10"></td>
<td colspan="8"></td>
<td colspan="11"></td>
<td colspan="12"></td>
<td colspan="9"></td>
<td colspan="11"></td>
<td colspan="8"></td>
<td colspan="7"></td>
<td colspan="6"></td>
<td colspan="7"></td>
<td colspan="10"></td>
<td colspan="8">,</td>
<td colspan="16"></td>
<td colspan="11">M</td>
<td colspan="19">M</td>
<td colspan="15">D</td>
<td colspan="17">D</td>
<td colspan="16">Y</td>
<td colspan="16">Y</td>
<td colspan="11">Y</td>
<td colspan="12">Y</td>
</tr>
<tr class="even">
<td colspan="83">Mother’s/Stepmother’s Social Security Number</td>
<td colspan="158">Mother’s/Stepmother’s Last Name, and First
Initial</td>
<td colspan="117">Mother’s/Stepmother’s Date of Birth</td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="5"></td>
<td colspan="4"></td>
<td colspan="5">-</td>
<td colspan="3"></td>
<td colspan="8"></td>
<td colspan="10">-</td>
<td colspan="9"></td>
<td colspan="13"></td>
<td colspan="11"></td>
<td colspan="12"></td>
<td colspan="13"></td>
<td colspan="7"></td>
<td colspan="8"></td>
<td colspan="11"></td>
<td colspan="11"></td>
<td colspan="7"></td>
<td colspan="11"></td>
<td colspan="13"></td>
<td colspan="9"></td>
<td colspan="8"></td>
<td colspan="11"></td>
<td colspan="5"></td>
<td colspan="7"></td>
<td colspan="8"></td>
<td colspan="7"></td>
<td colspan="8"></td>
<td colspan="7">,</td>
<td colspan="10"></td>
<td colspan="13">M</td>
<td colspan="16">M</td>
<td colspan="16">D</td>
<td colspan="16">D</td>
<td colspan="16">Y</td>
<td colspan="16">Y</td>
<td colspan="12">Y</td>
<td colspan="10">Y</td>
</tr>
<tr class="even">
<td colspan="112"><strong>34.</strong> For 2004, have your parents
completed their IRS income tax return or another tax return listed in
question 35?</td>
<td colspan="79">⁫ My parents have already completed their return.</td>
<td colspan="83">⁫ My parents will file, but they have not yet completed
their return.</td>
<td colspan="84">⁫ My parents are not going to file. <strong>(Skip to
question 39)</strong></td>
</tr>
<tr class="odd">
<td colspan="44"><strong>35.</strong> What income tax return did your
parents file or will they file for 2004?</td>
<td colspan="29">⁫ IRS 1040</td>
<td colspan="59">⁫ IRS 1040A, 1040EZ, 1040 Telefile</td>
<td colspan="59">⁫ A foreign tax return. <strong>(See page
2.)</strong></td>
<td colspan="167">⁫ A tax return for Puerto Rico, Guam, American Samoa,
the US Virgin Islands, the Marshall Islands, the Federated States of
Micronesia, or Palau. <strong>(See page 2)</strong></td>
</tr>
<tr class="even">
<td colspan="281"><strong>36.</strong> If your parents have filed or
will file a 1040, were they eligible to file a 1040A or 1040EZ?
<strong>(See page 2)</strong></td>
<td colspan="77">⁫ Yes ⁫ No</td>
</tr>
<tr class="odd">
<td colspan="281"><strong>37.</strong> In the past 24 months, have you
or your parents participated in a federal means-tested program?
<strong>(See page 2)</strong></td>
<td colspan="77">⁫ Yes ⁫ No</td>
</tr>
<tr class="even">
<td colspan="281"><strong>38.</strong> What was your parents’ adjusted
gross income for 2004? Adjusted gross income is on IRS Form 1040-line34;
1040A-line 21; 1040EZ-line 4; or Telefile-line I.</td>
<td colspan="11">$</td>
<td colspan="10"></td>
<td colspan="8"></td>
<td colspan="14"></td>
<td colspan="10">,</td>
<td colspan="10"></td>
<td colspan="12"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="238" rowspan="2"><p><strong>39.</strong> How much did your
parents earn from working (wages, salaries, tips, etc.) in 2004?</p>
<p>Answer this question whether or not your parents filed a tax return.
This information may be on their W-2 forms, or on IRS Form 1040-lines
7+12+18; 1040A-line 7; or 1040EZ-line 1.</p>
<p>Telefilers should use their W-2 forms.</p></td>
<td colspan="43">Father/ Stepfather</td>
<td colspan="11">$</td>
<td colspan="10"></td>
<td colspan="8"></td>
<td colspan="14"></td>
<td colspan="10">,</td>
<td colspan="10"></td>
<td colspan="12"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="43"><p>Mother/</p>
<p>Stepmother</p></td>
<td colspan="11">$</td>
<td colspan="10"></td>
<td colspan="8"></td>
<td colspan="14"></td>
<td colspan="10">,</td>
<td colspan="10"></td>
<td colspan="12"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="358"><strong>Step Five: Please tell us which schools may
request your information and your enrollment level.</strong></td>
</tr>
<tr class="even">
<td colspan="358"><strong>40.</strong> Enter the 6-digit federal school
code and your housing plans. Look for the federal school codes at <a
href="http://www.fafsa.ed.gov/">www.fafsa.ed.gov</a>, at your college
financial aid office, at your public library, or by asking your high
school guidance counselor. If you cannot get the federal school code,
write in the complete name, address, city, and state of the college. For
state aid, you may wish to list your preferred school first.</td>
</tr>
<tr class="odd">
<td colspan="44">1<sup>st</sup> Federal School Code</td>
<td colspan="13" rowspan="2"><em>OR</em></td>
<td colspan="194">Name of College Address and City of College</td>
<td colspan="28">State</td>
<td colspan="79"><strong>HOUSING PLANS</strong></td>
</tr>
<tr class="even">
<td colspan="3"></td>
<td colspan="5"></td>
<td colspan="6"></td>
<td colspan="7"></td>
<td colspan="7"></td>
<td colspan="16"></td>
<td colspan="101"></td>
<td colspan="93"></td>
<td colspan="10"></td>
<td colspan="18"></td>
<td colspan="79"><p>⁫ on campus</p>
<p>⁫ off campus</p>
<p>⁫ with parent</p></td>
</tr>
<tr class="odd">
<td colspan="44">2<sup>nd</sup> Federal School Code</td>
<td colspan="13" rowspan="2"><em>OR</em></td>
<td colspan="194">Name of College Address and City of College</td>
<td colspan="28">State</td>
<td colspan="79" rowspan="2"><p>⁫ on campus</p>
<p>⁫ off campus</p>
<p>⁫ with parent</p></td>
</tr>
<tr class="even">
<td colspan="3"></td>
<td colspan="5"></td>
<td colspan="6"></td>
<td colspan="7"></td>
<td colspan="7"></td>
<td colspan="16"></td>
<td colspan="101"></td>
<td colspan="93"></td>
<td colspan="10"></td>
<td colspan="18"></td>
</tr>
<tr class="odd">
<td colspan="44">3<sup>rd</sup> Federal School Code</td>
<td colspan="13" rowspan="2"><em>OR</em></td>
<td colspan="194">Name of College Address and City of College</td>
<td colspan="28">State</td>
<td colspan="79" rowspan="2"><p>⁫ on campus</p>
<p>⁫ off campus</p>
<p>⁫ with parent</p></td>
</tr>
<tr class="even">
<td colspan="3"></td>
<td colspan="5"></td>
<td colspan="6"></td>
<td colspan="7"></td>
<td colspan="7"></td>
<td colspan="16"></td>
<td colspan="101"></td>
<td colspan="93"></td>
<td colspan="10"></td>
<td colspan="18"></td>
</tr>
<tr class="odd">
<td colspan="44">4<sup>th</sup> Federal School Code</td>
<td colspan="13" rowspan="2"><em>OR</em></td>
<td colspan="193">Name of College Address and City of College</td>
<td colspan="27">State</td>
<td colspan="81" rowspan="2"><p>⁫ on campus</p>
<p>⁫ off campus</p>
<p>⁫ with parent</p></td>
</tr>
<tr class="even">
<td colspan="4"></td>
<td colspan="5"></td>
<td colspan="6"></td>
<td colspan="7"></td>
<td colspan="7"></td>
<td colspan="15"></td>
<td colspan="98"></td>
<td colspan="95"></td>
<td colspan="10"></td>
<td colspan="17"></td>
</tr>
<tr class="odd">
<td colspan="44">5<sup>th</sup> Federal School Code</td>
<td colspan="13" rowspan="2"><em>OR</em></td>
<td colspan="193">Name of College Address and City of College</td>
<td colspan="27">State</td>
<td colspan="81" rowspan="2"><p>⁫ on campus</p>
<p>⁫ off campus</p>
<p>⁫ with parent</p></td>
</tr>
<tr class="even">
<td colspan="4"></td>
<td colspan="5"></td>
<td colspan="6"></td>
<td colspan="7"></td>
<td colspan="7"></td>
<td colspan="15"></td>
<td colspan="98"></td>
<td colspan="95"></td>
<td colspan="10"></td>
<td colspan="17"></td>
</tr>
<tr class="odd">
<td colspan="358"><p><strong>41. (See page 5.)</strong> At the start of
the 2005-06 academic year, please mark if you will be: <strong>(CA
Only)</strong></p>
<p>⁫ Full-Time ⁫ ¾ time ⁫ Half-time ⁫ Less than half-time ⁫ Not Sure</p></td>
</tr>
<tr class="even">
<td colspan="124"><strong>42.</strong> <strong>(See page 5)</strong>
Number of members in your household</td>
<td colspan="11"></td>
<td colspan="206">Of these, how many will be college students between
July 1, 2004 and June 30, 2005?</td>
<td colspan="17"></td>
</tr>
<tr class="odd">
<td colspan="358"><p><strong>Step Six:</strong> 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, (4) will notify your
school if you default on a federal student loan, and (5) will not
receive a Federal Pell Grant for more than one school for the same
period of time.</p>
<p>If you are the parent of 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 <strong>the
Secretary of Education has the authority to verify information reported
on this application with the Internal Revenue Service and other federal
agencies.</strong> If you purposely give false or misleading
information, you may be fined $20,000, sent to prison, or both.</p></td>
</tr>
<tr class="even">
<td colspan="101"><strong>43.</strong> Signature(s) / Date this form was
completed</td>
<td colspan="257">Student <strong>X</strong></td>
</tr>
<tr class="odd">
<td colspan="5">M</td>
<td colspan="7">M</td>
<td colspan="6">D</td>
<td colspan="12">D</td>
<td colspan="71">⁫ 2004 ⁫2005</td>
<td colspan="257">Parent (A parent from Step Four)
<strong>X</strong></td>
</tr>
<tr class="even">
<td colspan="101" rowspan="3"><strong>44.</strong> If this form was
filled out by someone other than you, your spouse, or your parent(s),
that person must complete this part.</td>
<td colspan="135" rowspan="3">Preparer’s name, firm, and address</td>
<td colspan="122">Preparer' Social Security Number</td>
</tr>
<tr class="odd">
<td colspan="11"></td>
<td colspan="10"></td>
<td colspan="11"></td>
<td colspan="14"><strong>-</strong></td>
<td colspan="12"></td>
<td colspan="12"></td>
<td colspan="12"><strong>-</strong></td>
<td colspan="11"></td>
<td colspan="12"></td>
<td colspan="11"></td>
<td colspan="6"></td>
</tr>
<tr class="even">
<td colspan="122">Employer ID Number</td>
</tr>
<tr class="odd">
<td colspan="236">Preparer’s Signature and Date <strong>X</strong></td>
<td colspan="13"></td>
<td colspan="9"></td>
<td colspan="15">-</td>
<td colspan="14"></td>
<td colspan="14"></td>
<td colspan="12"></td>
<td colspan="14"></td>
<td colspan="13"></td>
<td colspan="12"></td>
<td colspan="6"></td>
</tr>
<tr class="even">
<td colspan="45"><strong>School Use Only:</strong></td>
<td colspan="39">D/O ⁬</td>
<td colspan="67">Federal School Code</td>
<td colspan="19"></td>
<td colspan="12"></td>
<td colspan="17"></td>
<td colspan="9"></td>
<td colspan="15"></td>
<td colspan="13"></td>
<td colspan="122" rowspan="2"><p><strong>Data Entry Use
Only:</strong></p>
<p><strong>⁬</strong> P <strong>⁬ * ⁬</strong>L <strong>⁬</strong>E</p></td>
</tr>
<tr class="odd">
<td colspan="236">FAA Signature <strong>X</strong></td>
</tr>
<tr class="even">
<td colspan="358"><strong>Page 4</strong> For Help - 1-800-433-3242</td>
</tr>
</tbody>
</table>