2019-2020
IDENTITY AND STATEMENT OF EDUCATIONAl PURPOSE
(To Be Signed With Notary)
(FFFA78)
S
TUDENT
I
NFORMATION
___________________________________________________________ ________________________________
Last Name First Name M.I.
Student ID#
IDENTITY AND STATEMENT OF EDUCATIONAL PURPOSE
If the student is unable to appear in person at
(Name of College)
to verify his or her identity, the student must provide:
a) A copy of the valid government-iss
ued photo identification (ID) that is acknowledged in the notary
statement below, such as but not limited to a driver's license, other state-issued ID, or passport;
and
b) The original notarized Statemen
t of Educational Purpose provided below.
S
TATEMENT OF EDUCATIONAL PURPOSE
I certify that I am the individual signing this Statement of
(Print Student’s name)
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 for 2019-2020
(Name of College)
(Student's Signature) (Date)
NOTARY'S CERTIFICATE OF ACKNOWLEDGEMENT
State of ______________________________________________________________________________________
City/County of ________________________________________________________________________________
On _______________________ , before me,
__________________________________________________,
(Date)
(Notary's name)
personally appeared, , and provided to me
(Printed name of signer)
on basis of satisfactory evidence of identification _________________________________________________
(Type of government-issued photo ID provided)
to be the above-named person who signed the foregoing instrument.
WITNESS my hand and official seal
(seal)
(Notary signature)
My commission expires on
(Date)
RETURN TO FINANCIAL AID OFFICE:
