By signing this certification, I certify the accuracy of my completed 2008-09 OSAC Scholarship application form and all accompanying documents, and, if requested, agree to provide proof of this information. I also give permission to the Oregon Student Assistance Commission (OSAC) to request and use data from my Free Application for Federal Student Aid (FAFSA) as well as data and materials from the application to determine my eligibility for OSAC scholarships.
I authorize OSAC to share my information with scholarship processing and review staff, donors, and selection committees for identifying students, determining eligibility, and selecting and notifying awardees. I give permission to selection committees to contact high school and college officials for additional academic and/or financial information. I also allow my information to be shared with OSAC-approved researchers.
If selected to receive a scholarship, I give permission for a publicity release.
Under the Privacy Act of 1974, I understand I am not required to provide my Social Security Number; however, if I don't provide it, I will not be considered for OSAC need-based scholarships.
OSAC cannot guarantee applicants will receive scholarships. Further, by signing this certification, I agree to hold harmless, defend, and indemnify OSAC for any acts, failures to act, or omissions of the Commission, its employees, agents, volunteers, or any State of Oregon employee.
Full Name: __________________________________________________
Birthdate: _____________________
Last 4 digits of SSN: ____________
5-digit eApp number (if you applied online): ____________
Signature: __________________________________________________
Date signed: _____________________
Mail or hand-deliver your signed certification to:
OSAC
1500 Valley River Drive, Suite 100
Eugene, Oregon 97401-2148