MAIL THIS COMPLETED FORM WITH IDENTIFICATION TO:
Wayne Community College Financial Aid Office PO Box 8002 Goldsboro, NC 27533-8002
Wayne Community College is accredited by the Southern Association of Colleges and Schools Commission on Colleges to award associate degrees. Contact the
Commission on Colleges at 1866 Southern Lane, Decatur, Georgia 30033-4097 or call 404-679-4500 for questions about the accreditation of Wayne Community College.
The Commission on Colleges may be contacted only if there is evidence that Wayne Community College is significantly non-compliant with a requirement or standard.
Accreditation standards are located at: http://www.sacscoc.org/principles.asp. Inquiries about Wayne Community College, such as admission requirements, financial aid,
educational programs, etc. should be addressed directly to Wayne Community College and not the Commission’s office.
NOTARY SEAL
My Commission Expires:
_____________________
2019-2020
Identity and Statement of Educational Purpose Off Campus
(Notary Certification Required)
If the student is unable to appear in person at Wayne Community College (WCC) to verify his or her
identity, the student must provide to the institution:
a) A copy of the unexpired valid government-issued photo identification (ID) that is acknowledged in the notary
statement below, or that is presented to a notary, such as, but not limited to, a driver’s license, other state-
issued ID, or passport; AND
b) The original Statement of Educational Purpose provided below, which must be notarized.
Statement of Educational Purpose
I certify that I, _____________________________________________, am the individual signing this
PRINT STUDENT NAME
Statement of Educational Purpose and that the Federal student financial assistance I may receive will
only be used for educational purposes and to pay the cost of attending Wayne Community College for
2019-2020.
__________________________________________ _________________
STUDENT SIGNATURE DATE
_____________________
STUDENT WCC ID NUMBER
Notary’s Certificate of Acknowledgement
State of ______________________________
City/County of __________________________________
I, ________________________________________, Notary Public, do hereby certify that
NOTARY’S NAME
____________________________________________, personally appeared before me on
PRINTED NAME OF SIGNER
_________________, and proved to me on the basis of satisfactory evidence of identification,
DATE
______________________________________ to be the above-named person who signed the
TYPE OF GOVERNMENT-ISSUED PHOTO ID PROVIDED
foregoing instrument.
WITNESS my hand and official seal
_____________________________________________
NOTARY SIGNATURE
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