Student Name/Social Security Number Confirmation

1 Write Student name and PSU ID on every page FSSN Student Name/Social Security Number Confirmation Student name : _____ PSU ID: _____ There is a conflict between the information you reported on your FAFSA and the information on record at Penn State and/or the Social Security Administration. Your name and Social Security Number must appear on all your federal, state, and Penn State records exactly as it appears on your Social Security card. After you take corrective action (see below), we will update our records to match your Social Security card.

2 We will also notify the appropriate agencies or institutions to correct your records through the National Student Loan Data System (NSLDS). If the name on your FAFSA does not match your Social Security card, update your FSA ID and correct your name on the FAFSA. You will receive an email from the Department of Education confirming the correction. You must also complete the following 3 sections and submit the required documents listed below: 1. A signed, legible copy of your Social Security card* AND this form, completed and signed. *If you are in the process of changing your name through the Social Security Administration, submit a copy of your new, signed Social Security card. If you lost your Social Security card, changed your name , and/or need a replacement, visit the Social Security Administration website for more information.

3 2. Please check the appropriate box below: I legally changed my name through marriage, divorce, or through the court system. I will provide proof of my legal name change ( marriage certificate, divorce decree , or other forms). I never legally changed my name . What is listed below as my first, middle, and last names is true and accurate. 3. Using black ink, print your name exactly as it appears on your Social Security card. First: _____ Middle name /Initial: _____ Last: _____ If you are a dependent Student , handwritten parent and Student signatures are required. By signing this document, I/we certify that all the information reported on it is complete and correct.

4 If I/we purposely give false or misleading information on this document, it will be cause for denial or repayment of Student aid and I/we may be fined, be sentenced to prison, or both. Student Signature: _____ Date: _____ Parent Signature: _____ Date: _____ Office of Student Aid 314 Shields Building University Park, PA 16802 Phone: (814) 865-6301 Fax: (814) 863-0322 Write Student name and PSU ID on every page FSSN Upload your form(s). Combine all your verification documents into one file to upload them. For instructions on how to do this or to upload additional files, please visit our website.

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