# STUDENT AID REPORT

Dear Your Student Aid Report (SAR) summarizes the information you submitted on your 2015-2016 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. 1845-0001 DATA RELEASE NUMBER (DRN): 

# 2015-2016

The EFC is not the amount of money that your family must provide. Rather, you should think of the EFC as an index that colleges use to determine how much financial aid you would receive if you were to attend their school. Financial aid may include grants (free funds that do not have to be repaid), work-study (paid part-time employment), and/or low-interest loans (borrowed funds that must be repaid). Please note that your EFC is subject to change if you update or correct your FAFSA. Your financial aid package could also include other federal, state, or institutional grants and scholarships, and/or a work-study award. Your 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, 2015 000001C001 JOHN SMITH 742 EVERGREEN TERRACE SPRINGFIELD OH 55555 EXPECTED FAMILY CONTRIBUTION (EFC): 000000*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 000000.



## ) )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 1516

Based on your EFC it appears thatyou may be eligible for a Federal Pell Grant of up to $5730, provided you have not met or exceeded the lifetime limit established for the Federal Pell Grant program. You may also be eligible for other grants, work-study opportunities, and low-interest student loans.

# 2015-2016 STUDENT AID REPORT The Office of Management and Budget (OMB) wants you to know that: 

### According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is 1845-0001. Public reporting burden for this collection of information is estimated to average between 10 to 20 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The obligation to respond to this collection is voluntary. If you have comments or concerns regarding the status of your individual submission of this form, please contact the Federal Student Aid Information Center, P.O. Box 84, Washington, D.C. 20044 directly. [Note: Please do not return the completed form to this address.] By answering questions 103a through 103h, 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 electronic credentials with anyone, including commercial service providers that provide assistance with the financial aid process. You should keep your credentials in a safe location. 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 2015-2016 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 Request Flag: Student: Parent: IRS Display 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: P1SSN Match Flag: P2SSN Match Flag: COMMENTS: Special Circumstances: Y 4A 4A Y D Y Y 1 A B C D E F G 01/01/2015 01/01/2015 Y



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

001 115 006 A 01

C 1 2 3 4 5 6 7 8 9 10 11 12 000000 000000 000000 000000 000000 000000 000000 000000 000000 000000 000000 000000 000000 000000 000000 000000 000000 000000 000000 000000 000000 000000 000000 000000

# 2015-2016 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. 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

# 2015-2016 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 electronic credentials 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. 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 Federal Family Education Loan (FFEL) Program 'Unallocated Consolidation Loans,' it is because we could not determine whether those balances were subsidized or unsubsidized. Remember, you are responsible for repaying all of the amounts that you borrow, plus interest. As a general rule, with an assumed interest rate of 5%, the monthly payment amount over a 10-year repayment period would be approximately $10.61 for every $1,000 that you borrowed. Of course, your actual repayment amount will depend upon how much you borrow, the interest rate when you enter repayment, and the length of your repayment term. Total Amount of Loans Outstanding: FFEL (Bank Loans) and/or Direct Loans: 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: 2015-2016 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. Your telephone 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, 2010? 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. 

# 2015-2016 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. If you do not have an e-mail address, leave this field blank.

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

Use MM/DD/YYYY format (e.g., 03/01/1996)

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

/ Male Female Register Me / /



### A OMB No.1845-0001

18. State of Legal Residence Abbreviation 10. Your telephone number (301) 555 - 1234



### PAGE 5 OF 10 Divorced or Widowed DRN: 9755
SMITH JOHN J Processed: 01/01/2015

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 36-45, report your (the student's) income and assets. If you are single, separated, divorced or widowed, answer only about yourself. If you are married or remarried, as of today, include information about your spouse. Remember to completely fill in the oval as follows: 29. Grade Level in College in 2015-2016

26. High School Completion Status?

28. First Bachelor's Degree by 7-1-2015? 25. Parent 2 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/State equivalent test...... 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: 2014 Student (and Spouse) Income and Assets 32. Filed 2014 Income Tax Return?
33. Type of 2014 Tax Form Used Already completed................. Will file........................................ Will not file................................. 1040............................................ 1040A/EZ.................................... Foreign tax return..................... U.S. Trust territory....................... 35. If you filed or will file a 1040, were you eligible to file a 1040A or 1040EZ? Yes.................................... No..................................... Don't know....................... For 36-45, 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 36. Adjusted Gross Income from IRS Form (1040-line 37; 1040A-line 21; or 1040EZ-line 4.) 

### $ , $ 37. U.S. Income Tax Paid from IRS Form (1040-line 56; 1040A-line 39; 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

38. 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 3RD

HS DIPLOMA

YES YES

ALREADY COMPLETED

1040 YES

$ 1,355,000 $ 1,113,012
03 PRINCE GEORGE'S COUNTY HIGH SCHOOL

BELTSVILLE

MD



### , $ , , 34. Tax Return Filing Status 2014 Single........................................ MARRIED-FILED SEPARATE RETURN Head of household................ Married-filed joint return........ Married-filed separate return Qualifying widow(er)............. Don't know............................... 

### , 1ST BA 24. Parent 1 Educational Level44. 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 45. 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 39. Student's Income Earned from Work 40. Spouse's Income Earned from Work
42. Net Worth of Investments (As of the date you submitted your FAFSA) 43. Net Worth of Businesses/Investment Farms (As of the date you submitted your FAFSA) 41. Cash, Savings, and Checking (As of the date you submitted your FAFSA) For 39-40, 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 46 - 58 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. 46. Born Before 1-1-1992?
48. Working on a master's or doctorate program in 2015-2016? 47. Are you married (As of the date you submitted your FAFSA)?

51. Have children who receive more than half of their support from you? 52. Have dependents other than children or spouse? 49. Are you on active duty in U.S. Armed Forces? 50. Are you a veteran of U.S. Armed Forces? Yes No Yes No Yes No

Yes No Yes No

Yes No Yes No 53. Were your parents deceased, were you in foster care or a court dependent/ward? 54. Are/Were an emancipated minor? 55. Are/Were in legal guardianship? 56. Have you been verified as a homeless youth?

58. Have you been verified as an unaccompanied youth who is at risk for homelessness? 57. 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 $ $ $

$ $

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

$ $ 1,250,000 $ 1,100,000

$ 12,000

$ 4,000 $ 20,000



### R5EN000001 999 YES

YES YES

NO YES NO NO

YES NO
NO 

### $ , , $ , , $ , , $ , , $ , ,
$ , , $ , , $ , , $ , , $ , , $ , , $ , , $ , , $ , , $ , , $ , , $ , , $ , , $ , , $ , , $ , ,59. Parents' Marital Status (As of the date you submitted your FAFSA) 61. Parent 1 Social Security Number 62. Parent 1 Last Name 63. First Initial 64. Parent 1 Date of Birth Married/Remarried Widowed................... 

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

69. Parents' E-mail Address

71. Parent legal resident of the state before January 1, 2010? 72. If "No" to question 71, enter the date parent became legal resident

75. Parent received Supplemental Security Income? 76. Parent received Supplemental Nutrition Assistance Program (SNAP)? 77. Parent received free/reduced price lunch? 78. Parent received Temporary Assistance for Needy Families (TANF)? 79. Parent received Nutrition Program for Women, Infants and Children (WIC)? Yes No

Yes No Yes No Yes No Yes No Yes No 73. Parents' number of family members in 2015-2016 74. Parents' number of family members in college in 2015-2016 60. Date of Marital Status

70. 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.

80. Filed 2014 Income Tax Return?
81. Type of 2014 Tax Form Used 83. If your parents' filed or will file a 1040, were they eligible to file a 1040A or 1040EZ? Yes...................................... No....................................... Don't know........................ 84. Are either of your parents a dislocated worker (As of the date you submitted your FAFSA)? Yes...................................... No....................................... Don't know........................ For 85-94, if the answer is zero or the question does not apply, enter 0. Report dollar amounts without cents. For 88-89, 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. 85. Adjusted Gross Income from IRS Form 86. U.S. Income Tax Paid 87. Exemptions Claimed 88. Parent 1 Income Earned from Work 89. Parent 2 Income Earned from Work 90. Cash, Savings, and Checking (As of the date you submitted your FAFSA) 91. Net Worth of Investments (As of the date you submitted your FAFSA) $

$ $
$ $ $ WIDOWED XXX-XX-0123 SMITH APRIL 21, 1975

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

### $ , , $ , , $ , , $ , , $ , , $ , , Unmarried and both parents living together Never married............... Divorced/Separated

1040A/EZ............................. Foreign tax return............. U.S. Trust territory................ 82. Tax Return Filing Status 2014 Single........................................ MARRIED-FILED SEPARATE RETURN Head of household................ Married-filed joint return........ Married-filed separate return Qualifying widow(er)............. Don't know............................... B Answer all questions in Step Four even if you do not live with your legal parents (your biological and/or adoptive parents). Grandparents, foster parents, legal guardians, aunts and uncles are not considered parents on this form unless they have legally adopted you. If your parents are married to each other, or are not married to each other and live together, answer the questions about both of them. See the Notes on page 9 of the FAFSA for information.

65. Parent 2 Social Security Number 66. Parent 2 Last Name 67. First Initial 68. Parent 2 Date of Birth 

### / / XXX-XX-0126 SMITH MARCH 24, 1976 T93. 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

94. Parents' Untaxed Income a) Tax-deferred pension/savings 94. 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 95. Number of Family Members in 2015-2016 96. Number in College in 2015-2016 97. Student received Supplemental Security Income? 98. Student received Supplemental Nutrition Assistance Program (SNAP)? 99. Student received free/reduced price lunch? 100. Student received Temporary Assistance for Needy Families (TANF)? 101. Student received Nutrition Program for Women, Infants and Children (WIC)? 102. 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 103.a First College Name, City and State NEW BRUNSWICK INSTITUTE OF TECHNOLOGY PORTLAND, OR New School Code New School Name, City, State 103.b Housing Plans

103.c Second College Name, City and State UNIVERSITY OF MARYLAND COLLEGE PARK, MD New School Code New School Name, City, State 103.d Housing Plans ON CAMPUS

ON CAMPUS 

### $ , , $ , , $ , , $ , , $ , , $ , ,
$ , , $ , , $ , , $ , , $ , , $ , , $ , , $ , , $ , , 92. Net Worth of Businesses/Investment Farms (As of the date you submitted your FAFSA) $ 

### $ , ,

### 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 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 related to the federal student aid programs electronically using a personal identification number (PIN), username and password, and/or any other credential, you certify that you are the person identified by that PIN, username and password, and/or other credential, and have not disclosed that PIN, username and password, and/or other credential 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 Federal Student Aid's Web site (www.fafsa.gov). 1

2 

### Data Entry Use Only

PAGE 10 OF 10Q Step Seven: Certification, Signatures and Date 104. Date Completed 105. Signed By? 106. Preparer's Social Security Number 107. Preparer's EIN 108. 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 103.e Third College Name, City and State UNIVERSITY OF MISSOURI ST LOUIS, MO New School Code New School Name, City, State 103.f Housing Plans

103.g Fourth College Name, City and State New School Code New School Name, City, State 103.h Housing Plans

For the graduation, retention, and transfer rates of the colleges listed on your FAFSA, view your Student Aid Report online at www.fafsa.gov. You can find these rates and other important consumer information about the colleges you're interested in attending at www.nces.ed.gov/collegenavigator. OFF CAMPUS

JANUARY 01, 2015 BOTH

01/05/2015



### 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 your Student Aid Report (SAR), and more". OFF CAMPUS UNIVERSITY OF TEXAS AUSTIN, TXAll 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 2014 U.S. Income Tax Form filed by me or my family. I understand that if I purposely give false or misleading information on this SAR, I may be fined up to $20,000, sent to prison, or both. If you made no changes: Do NOT send your SAR to the address given on this page. Follow the instructions on your SAR. You may need to contact your school. If you made changes: You may make corrections from Federal Student Aid's Web site ( www.fafsa.gov). 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 104. Date Completed 105. Signed By? 106. Preparer's Social Security Number 107. Preparer's EIN 108. 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 103.e Third College Name, City and State UNIVERISTY OF MISSOURI ST LOUIS, MO New School Code New School Name, City, State 103.f Housing Plans

103.g Fourth College Name, City and State New School Code New School Name, City, State 103.h Housing Plans OFF CAMPUS

JANUARY 01, 2015 BOTH

01/05/2015 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 your Student Aid Report (SAR), and more".



### R5EN000001 999 UNIVERISTY OF TEXAS AUSTIN, TX OFF CAMPUS

For the graduation, retention, and transfer rates of the colleges listed on your FAFSA, view your Student Aid Report online at www.fafsa.gov. You can find these rates and other important consumer information about the colleges you're interested in attending at www.nces.ed.gov/collegenavigator.