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19.10.2023, 14:43 2023-2024 Print Signature | FAFSA Application | Federal Student Aid

2023–24 FAFSA® Signature Page

2324 17125592000BA

Daria Baitazarova Ref: 171255920 00 BA
16 Outlook Cir Date Printed: 10/19/23
Pacifica, CA 94044

Step One: Read the following.

Students: By signing a signature page and mailing it to us, you certify that you

will use federal and/or state student financial aid only to pay the cost of attending an institution of higher education,
are not in default on a federal student loan or have made satisfactory arrangements to repay it,

do not owe money back on a federal student grant or have made satisfactory arrangements to repay it,
will notify your school if you default on a federal student loan, and

will not receive a Federal Pell Grant from more than one school for the same period of time.

Students and Parents: By signing a signature page and mailing it to us, 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, and
U.S. or state income tax forms that you filed or are required to file.

You also certify that you understand that the secretary of education has the authority to verify information reported on your application with the Internal Revenue Service and
other federal agencies. If you purposely give false or misleading information, you may be fined up to $20,000, sent to prison, or both.

Step Two: Sign below unless otherwise noted.
Student Signature: NOT REQUIRED TO SIGN Date:

Parent Signature: Date: 11.12.2023
If parental information is provided on the FAFSA form, at least ONE parent whose information is provided must sign.

Preparer's Certification: All of the information on this form is true and complete to the best of my knowledge.

Preparer’s Signature: NOT REQUIRED TO SIGN 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 sign.

Step Three: Mail the signature page to the following address:
Federal Student Aid Programs
P.O. Box 7656
London, KY 40742-7656

If you have questions, call the Federal Student Aid Information Center at 1-800-4-FED-AID (1-800-433-3243).

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