DRAFT DATE: SEPTEMBER 25, 2012

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 that you 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 999
1. 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 you find a mistake, put the correct answer in the boxes or completely fill in an oval

(example: ).

Look for arrows ( or ) in the area next to your information. For these items, give us 

a new answer, or if your current answer is correct, rewrite the same information exactly.

If you want to delete an answer, draw a line through your answer and through the empty 

box or oval (example: ).

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

MD
43. 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

NO
58. 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...................

R5EN000001 999 PAGE 9 OF 10

$ 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.

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 sign any 

document related to the federal student aid programs electronically using a Personal Identification Number (PIN), you certify that you are the person 

identified by the PIN and have not disclosed that PIN to anyone else. If you purposely give false or misleading information, you may be fined up to 

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

If you made no changes:

 Do NOT send your SAR to the address given on this page.

 Follow the instructions on your SAR. You may need to 

 contact your school.

If you made changes:

 You may make corrections from Federal Student Aid's Web site 

 (www.fafsa.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