# STUDENT AID REPORT

Dear Your Student Aid Report (SAR) summarizes the information you submitted on your 2013 - 2014 Free Application for Federal Student Aid (FAFSA). Application Status (review the checked boxes)

Federal Student Aid Eligibility (review the checked boxes)

You should keep this SAR for your records! PAGE 1 OF 10 WWW.FAFSA.GOV OMB No. 1845-0008 DATA RELEASE NUMBER (DRN): 

# 2013-2014

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), low-interest loans (borrowed funds that must be repaid), and/or work-study (paid part-time employment). 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 schools 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, loans, work-study, scholarships and other sources of aid, go to StudentAid.gov. APRIL 22, 2013 000001C001 JOHN SMITH 742 EVERGREEN TERRACE SPRINGFIELD OH 55555 EXPECTED FAMILY CONTRIBUTION (EFC): 00000*C

9755

JOHN SMITH,
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. 

## ) )

The data submitted on your FAFSA is used to calculate your Expected Family Contribution (EFC), which is 00000.



## ) ) 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.

R5EN000001 999 F 211 1314

Based on your EFC it appears thatyou may be eligible for a Federal Pell Grant of up to $5350, 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, low-interest student loans, and work-study opportunities.

# 2013-2014 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, which for this form is 1845-0008. Public reporting burden for this collection of information is estimated to average 10 to 34 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. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Federal Student Aid Information Center, P.O. Box 84, Washington, D.C. 20044. By answering questions 101a through 101h, 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 10 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 2013-2014 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.



### PAGE 2 OF 10 SAR C Flag: Application Source: Transaction Source: Processed Record Type: Duplicate SSN Flag: High School Flag: Dependency Status: Dependency Override: Professional Judgment: Reprocessing Code: Rejects Met: Application Receipt Date: Transaction Receipt Date: Verification Flag: IRS Flag: Student: Parent: MONTHS: PRIMARY EFC: SECONDARY EFC: PC: SIC: Auto Zero EFC Flag: Simplified Needs Test Flag: Pell Eligible Flag: MATCH FLAGS: SSN Match Flag: DHS Match Flag: DHS Sec. Conf. Flag: NSLDS Match Flag: NSLDS Unusual Enrollment History Flag: Selective Service Registration Flag: DHS Verification #: VA Match Flag: NSLDS Results Flag: NSLDS Transaction Number: Selective Service Match: SSA Citizenship Code: FSSN Match Flag: MSSN Match Flag: COMMENTS: Special Circumstances: 1 2 3 4 5 6 7 8 9 10 11 12 Y 4A 4A Y D Y Y 1 A B C D E F G 01/01/2013 01/01/2013 Y



### R5EN000001 999 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000
Y 4 2 1 Y Y 1 01 999999999999999 Y C 4 4 01

001 115 006 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000

# 2013-2014 STUDENT AID REPORT COMMENTS ABOUT YOUR INFORMATION

PAGE 3 OF 10 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.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 visit www.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.

R5EN000001 999

# 2013-2014 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 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.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 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: Total Principal Balance: Remaining Amount to be Disbursed: Total: Subsidized Loans: Unsubsidized Loans: Combined Loans: Unallocated Consolidated Loans: Federal Perkins Loans: Total Outstanding Principal Balance: 2013-2014 Award Year Loan Amount: Teach Grants Converted to Direct Loans:

PAGE 4 OF 10 Unsubsidized Loans: $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 1,612 1,612 6,000 1,200 7,200 3,000 N/A N/A 4,300 N/A N/A 1,300 N/A N/A 550

R5EN000001 9991. Last Name 2. First Name 3. Middle Initial 4. Mailing Address 5. City 6. State Abbreviation 7. ZIP Code 8. Social Security Number 9. Date of Birth 10. Permanent Phone Number
11. Driver's License Number 12. Driver's License State Abbreviation
13. Student's E-mail Address 14. Citizenship Status 15. Alien Registration Number 16. Marital Status (As of the date you submitted your FAFSA) 17. Date of Marital Status Change
19. Did you become a legal resident of this state before January 1, 2008? 20. If you answered "No" to question 19, date you became a legal resident 21. Are you male or female? 22. If you are male (age 18-25) and not registered, answer "Register Me" and Selective Service will register you. 

# 2013-2014 STUDENT AID REPORT

Step One: You (The Student)

U.S. Citizen Eligible Noncitizen Neither

Yes No Remember to completely fill in the oval 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. Leave this field blank to receive information through postal mail.

Single Married/Remarried Separated Check Your SAR If youfind 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: ). Use your Federal Student Aid PIN to make corrections online at www.fafsa.gov or send in pages 5-10 of this form.

Use MM/DD/YYYY format (e.g., 03/01/1980)

@

Use MM/YYYY format (e.g., 03/1980) /

/ Male Female Register Me / /



### A OMB No. 1845-0008

18. State of Legal Residence Abbreviation 10. Permanent Phone Number (301) 555 - 1234



### PAGE 5 OF 10 Divorced or Widowed DRN: 9755
SMITH JOHN J Processed: 04/20/2013

742 EVERGREEN TERRACE
SPRINGFIELD
XXX-XX-4444

JOHNSMITH@HOTMAIL.COM

MARRIED/REMARRIED
IL YES MALE REGISTER ME (555) 235-1885

ELIGIBLE NONCITIZEN



### R5EN000001 999 Use MM/YYYY format (e.g., 03/2011)For 35-44, 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 (husband or wife). Remember to completely fill in the oval as follows: 29. Grade Level in College in 2013-2014

26. High School Completion Status?

28. First Bachelor's Degree by 7-1-2013? 24. Father's Educational Level
25. Mother's Educational Level 23. Drug Conviction Affecting Eligibility? 1st/Never Attended..................

1st/Previously Attended........... 2nd/Sophomore...................... 3rd/Junior................................. 4th/Senior................................. 5th/Other Undergraduate..... 1st Yr. Graduate/ Professional.............................. Cont. Graduate/ Professional..............................

Yes No Middle school/Jr. High.......... High school............................. College or beyond................ Other/unknown...................... Middle school/Jr. High.......... High school............................. College or beyond................ Other/unknown...................... No............................................. Yes (Part-Year)........................ Yes/Don't know......................

30. Type of Degree/Certificate High school diploma.............. GED certificate......................... Homeschooled........................ None of the above..................

31. Are you interested in being considered for work-study? Yes..................................... No...................................... Don't know.......................



### PAGE 6 OF 10 1st Bachelor's degree............ 2nd Bachelor's degree......... Associate degree (occupational or technical program)................................ Certificate or diploma for completing less than 2 years Teaching credential (nondegree program).......... Graduate or professional degree..................................... Other/undecided..................



### Step Two: 2012 Student (and Spouse) Income and Assets 32. Filed 2012 Income Tax Return? 33. Type of 2012 Tax Form Used Already completed................. Will file........................................ Will not file................................. 1040............................................ 1040A/EZ.................................... Foreign tax return..................... U.S. Trust territory....................... 34. If you filed or will file a 1040, were you eligible to file a 1040A or 1040EZ? Yes.............................................. No............................................... Don't know................................ For 35-44, 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 35. Adjusted Gross Income from IRS Form (1040-line 37; 1040A-line 21; or 1040EZ-line 4.) 

### $ , $ 36. U.S. Income Tax Paid from IRS Form (1040-line 55; 1040A-line 35; or 1040EZ-line 10.) 

### $ , $ You Told Us You Told Us

Associate degree (general

education or transfer).......... Certificate or diploma for completing at least 2 years

37. Exemptions Claimed from IRS Form (1040-line 6d; 1040A-line 6d; for Form 1040EZ see page 2 of the FAFSA.) 27.a High School Name
27.b High School City
27.c High School State ELIGIBLE FOR AID



### R5EN000001 999 HIGH SCHOOL
COLLEGE OR BEYOND 3RD/JUNIOR

HIGH SCHOOL DIPLOMA

YES YES

ALREADY COMPLETED
1040

YES $ 355,000 $ 13,012 03 PRINCE GEORGE'S COUNTY HIGH SCHOOL

BELTSVILLE

MD43. Student's Additional Financial Information a) Education credits b) Child support paid c) Taxable earnings from need-based employment d) Taxable student grant and scholarship aid reported to IRS e) Combat pay/special combat pay 44. Student's Untaxed Income a) Tax-deferred pension/savings b) IRA deductions and payments c) Child support received d) Tax-exempt interest income e) Untaxed IRA distributions f) Untaxed portions of pensions g) Military or clergy allowances h) Veterans noneducation benefits i) Other untaxed income j) Money received or paid on your behalf 

### $ ,

$ , $ , $ , $ , $ , $ , $ , $ , $ , $ , $ , $ , $ , $ , $

$ $



### PAGE 7 OF 10 38. Student's Income Earned from Work 39. Spouse's Income Earned from Work 

### $ , $ , 41. Net Worth of Investments (As of the date you submitted your FAFSA) 42. Net Worth of Businesses/Investment Farms (As of the date you submitted your FAFSA) 40. Cash, Savings, and Checking (As of the date you submitted your FAFSA) For 38-39, 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 (Code A) of IRS Schedule K-1 (Form 1065); 1040A-line 7; or 1040EZ-line 1.


### $ , $ , $ ,

Step Three: Student Dependency Status Answer questions 45 - 57 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. 45. Born Before 1-1-1990?
47. Working on a master's or doctorate program in 2013-2014? 46. Are you married (As of the date you submitted your FAFSA)?

50. Have children who receive more than half of their support from you? 51. Have dependents other than children or spouse? 48. Are you on active duty in U.S. Armed Forces? 49. Are you a veteran of U.S. Armed Forces? Yes No Yes No Yes No

Yes No Yes No

Yes No Yes No 52. Were your parents deceased, were you in foster care or a court dependent/ward? 53. Are/Were an emancipated minor? 54. Are/Were in legal guardianship? 55. Have you been verified as a homeless youth?
57. Have you been verified as an unaccompanied youth who is at risk for homelessness? 56. Has the Department of Housing and Urban Development determined you to be homeless? Yes No Yes No Yes No Yes No Yes No Yes No f) Earnings from work under a cooperative education program 

### $ , $ $ $

$ $

$ $ $ $ $ $ $ $ $
$ $ $

$ $ 250,000 $ 100,000

$ 12,000

$ 4,000 $ 20,000



### R5EN000001 999 YES

YES YES

NO YES NO NO

YES NO NO58. Parents' Marital Status (As of the date you submitted your FAFSA) 60. Your Father's/Stepfather's Social Security Number 61. Your Father's/Stepfather's Last Name 62. First Initial 63. Father's/Stepfather's Date of Birth 64. Your Mother's/Stepmother's Social Security Number 65. Your Mother's/Stepmother's Last Name 66. First Initial 67. Mother's/Stepmother's Date of Birth Married/Remarried Single........................ Divorced/Separated Widowed.................... Answer all the questions in Step Four about your parents even if you do not live with them. 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 living and married to each other, answer the questions about them. If your parent is single, widowed, divorced, separated or remarried, see the Notes on page 9 of the FAFSA for information. 

### Step Four (Parental Information):Complete this step if you (the student) answered "No" to all questions in Step Three.

68. Parents' E-mail Address @ 70. Parent legal resident of the state before January 1, 2008? 71. If "No" to question 70, enter the date parent became legal resident

74. Parent received Supplemental Security Income? 75. Parent recieved Supplemental Nutrition Assistance Program (SNAP)? 76. Parent received free/reduced price lunch? 77. Parent received Temporary Assistance for Needy Families (TANF)? 78. Parent received Nutrition Program for Women, Infants and Children (WIC)? Yes No

Yes No Yes No Yes No Yes No Yes No 72. Parents' number of family members in 2013-2014 73. Parents' number of family members in college in 2013-2014 59. Date of Marital Status

69. Parents' state of legal residence 

### /

/ /
/ /

PAGE 8 OF 10 / Use MM/YYYY format (e.g., 03/2011) Provide an e-mail address so that we can correspond with your parents.

79. Filed 2012 Income Tax Return?
80. Type of 2012 Tax Form Used 81. If your parents' filed or will file a 1040, were they eligible to file a 1040A or 1040EZ? Yes...................................... No....................................... Don't know........................ 82. Are either of your parents a dislocated worker (As of the date you submitted your FAFSA)? Yes...................................... No....................................... Don't know........................ For 83-92, if the answer is zero or the question does not apply, enter 0. Report dollar amounts without cents. For 86-87, this information may be on W-2 forms, or on IRS Form 1040-lines 7+12+18+ Box 14 (Code A) of IRS Schedule K-1 (Form 1065); 1040A-line 7; or 1040EZ-line 1. 83. Adjusted Gross Income from IRS Form 84. U.S. Income Tax Paid 85. Exemptions Claimed 86. Father's/Stepfather's Income Earned from Work 87. Mother's/Stepmother's Income Earned from Work 88. Cash, Savings, and Checking (As of the date you submitted your FAFSA) 89. Net Worth of Investments (As of the date you submitted your FAFSA) 90. Net Worth of Businesses/Investment Farms (As of the date you submitted your FAFSA) 

### $ , $ , $ , $ , $ , $ , $ , $

$ $
$ $ $

$ WIDOWED XXX-XX-0123 SMITH APRIL 23, 1964

XXX-XX-0143 SMITH MAY 12, 1966
SMITHPARENTS@INTERNET.COM
IL YES

YES YES YES YES

WILL NOT FILE

FOREIGN TAX RETURN DON'T KNOW

$ 10,000
03

$ 155,000



### R5EN000001 999 1040..................................... 1040A/EZ............................. Foreign tax return............. U.S. Trust territory................ Already completed.......... Will file................................. Will not file..........................91. Parents' Additional Financial Information a) Education credits b) Child support paid c) Taxable earnings from need-based employment d) Taxable student grant and scholarship aid reported to IRS e) Combat pay/special combat pay 

### $ ,

$ , $ , $ , $ ,

92. Parents' Untaxed Income a) Tax-deferred pension/savings b) IRA deductions and payments c) Child support received d) Tax-exempt interest income e) Untaxed IRA distributions f) Untaxed portions of pensions g) Military or clergy allowances h) Veterans noneducation benefits i) Other untaxed income 

### $ , $ , $ , $ , $ , $ , Step Five: Student's Household Information 93. Number of Family Members in 2013-2014 94. Number in College in 2013-2014 95. Student received Supplemental Security Income? 96. Student received Supplemental Nutrition Assistance Program (SNAP)? 97. Student received free/reduced price lunch? 98. Student received Temporary Assistance for Needy Families (TANF)? 99. Student received Nutrition Program for Women, Infants and Children (WIC)? 100. Are you or your spouse a dislocated worker (As of the date you submitted your FAFSA)? Yes No Yes No Yes No Yes.................. No...................



### PAGE 9 OF 10 R5EN000001 999 $ 12,445

$ 19,778

$ 5,000 $ 2,000
$ 3,000

05 1 NO NO NO NO NO NO Don't know.... DRN:1421



### $ , $ ,
Yes No Yes No 

### $ ,
f) Earnings from work under a cooperative education program 

### $ , $ 401 $ $ $

$ $ $

$
$ $



### Step Six: Student's School Information Housing Plans:

2 --w/parents 1 -- on campus 3 -- off campus 101.a First College Name, City and State NEW BRUNSWICK INSTITUTE OF TECHNOLOGY PORTLAND, OR New School Code New School Name, City, State 101.b Housing Plans

101.c Second College Name, City and State UNIVERSITY OF MARYLAND COLLEGE PARK, MD New School Code New School Name, City, State 101.d Housing Plans ON CAMPUS

ON CAMPUS

### Please read, sign and date. You must read and sign this Certification. Ifyou arethe student, by signingthis applicationyou certifythatyou (1)will usefederal and/or state studentfinancial aid onlyto paythe 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 thatthe 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 relatedtothefederal student aid programs electronically using a Personal Identification Number (PIN),you certifythatyou arethe person identified bythe PIN and have not disclosedthat PINto anyone else. Ifyou purposely givefalse or misleading information,you may befined upto $20,000, sent to prison, or both. Student Signature (Required to process your application. Sign in box below.)
Parent Signature (one parent whose information is provided in Step Four).



### P * L E 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.gov). You must use your PIN to access your record online. 1

2 

### Data Entry Use Only
PAGE 10 OF 10Q Step Seven: Certification, Signatures and Date 102. Date Completed 103. Signed By? 104. Preparer's Social Security Number 105. Preparer's EIN 106. Preparer's Signature Application Receipt Date: DO NOT CORRECT DO NOT CORRECT

Student Date

Parent Date If you or your family paid a fee for someone to fill out this form or to advise you on how to fill it out, that person must complete this part. Housing Plans: 2 --w/parents 1 -- on campus 3 -- off campus 101.e Third College Name, City and State UNIVERISTY OF MISSOURI ST LOUIS, MO New School Code New School Name, City, State 101.f Housing Plans

101.g Fourth College Name, City and State New School Code New School Name, City, State 101.h Housing Plans

For more information about the colleges you listed on your FAFSA, visit College Navigator at www.nces.ed.gov/collegenavigator or view your Student Aid Report online at www.fafsa.gov for the graduation, retention, and transfer rates. OFF CAMPUS

JANUARY 13, 2013 BOTH

01/01/2013



### JOHN SMITH

R5EN000001 999 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.gov and select View Processed Information".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 2012 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. I f 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.gov ).You must use your PIN to access your record. 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 OR

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) 

### PAGE 10 OF 10V Please read, sign and date. You must read and sign this Certification.

Student Signature (Required to process your application. Sign in box below.)
Parent Signature (one parent whose information is provided in Step Four).



### P * L E 1

2 

### Data Entry Use Only Student Date

Parent Date 

### JOHN SMITH Step Seven: Certification, Signatures and Date 102. Date Completed 103. Signed By? 104. Preparer's Social Security Number 105. Preparer's EIN 106. Preparer's Signature Application Receipt Date: DO NOT CORRECT DO NOT CORRECT If you or your family paid a fee for someone to fill out this form or to advise you on how to fill it out, that person must complete this part. Housing Plans: 2 --w/parents 1 -- on campus 3 -- off campus 101.e Third College Name, City and State UNIVERISTY OF MISSOURI ST LOUIS, MO New School Code New School Name, City, State 101.f Housing Plans

101.g Fourth College Name, City and State New School Code New School Name, City, State 101.h Housing Plans

For more information about the colleges you listed on your FAFSA, visit College Navigator at www.nces.ed.gov/collegenavigator or view your Student Aid Report online at www.fafsa.gov for the graduation, retention, and transfer rates. OFF CAMPUS

JANUARY 13, 2013 BOTH

01/01/2013 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.gov and select View Processed Information".



### R5EN000001 999