2020 - 2021
Identity and Statement of Educational Purpose
(To Be Signed at the Institution)
Student Name Student ID Phone Number
The student must appear in person at
Caldwell Community College and Technical Institute
to verify his
or her
identity by presenting an unexpired valid government-issued photo identification (ID), such as, but not
limited to, a driver’s license, other state-issued ID, or passport. The institution will maintain a copy of
the student’s photo ID that is annotated by the institution with the date it was received and reviewed, and the
name of the official at the institution authorized to receive and review the student’s ID.
In addition, the student must sign, in the presence of the institutional official, the Statement of Educational
Purpose provided below.
Statement of Educational Purpose
I certify that I, , am the individual signing this
(Print Student’s Name)
Statement of Educational Purpose and that the Federal student financial assistance I may receive willonlybe
used for educational purposes and to pay the cost of attending Caldwell Community College and Technical
Institute for 2020–2021.
Certification and Signatures:
I understand if I purposely give false or misleading information I may be fined, sentenced to jail, or both.
Student Signature Date
Return completed worksheet(s) to:
Caldwell Community College and Technical Institute
Office of Financial Aid
E-mail finaid@cccti.edu
Caldwell Campus 2855 Hickory Blvd., Hudson, NC 28638 Watauga Campus PO Box 3318, Boone, NC 28607
Fax: 828.726.2709 Fax: 828.297.1729
VERIFICATION OF UNEXPIRED VALID GOVERNMENT ISSUED ID
Type of ID provided:
Driver’s License Non-Driving State ID Passport Other:
CCC&TI Authorized Official Signature Date
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signature
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signature
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2020 - 2021
Identity and Statement of Educational Purpose
(To Be Signed in the Presence of a Notary)
Student Name Student ID Phone Number
If the student is unable to appear in person at
Caldwell Community College and Technical Institute
to
verify his or
her identity, the student must provide to the institution:
(a)
A legible 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. If the notary
statement appears on a separate page than the Statement of Educational Purpose, there must be a clear
indication that the Statement of Educational Purpose was the document notarized.
Statement of Educational Purpose
I certify that I am the individual signing this
(Print Student’s 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 Caldwell Community College and Technical
Institute for 2020–2021.
Certification and Signatures:
I understand if I purposely give false or misleading information I may be fined, sentenced to jail, or both.
Student Signature Date
Return completed worksheet(s) to:
Caldwell Community College and Technical Institute
Office of Financial Aid
E-mail finaid@cccti.edu
Caldwell Campus 2855 Hickory Blvd., Hudson, NC 28638 Watauga Campus PO Box 3318, Boone, NC 28607
Fax: 828.726.2709 Fax: 828.297.1729
Notary’s Certificate of Acknowledgement
State of City/County of /
On this day,
appeared,
satisfactory evidence of identification
, before me,
, and proved
,
to me on t
personally
he basis of
(Type of unexpired government-issued photo ID provided)
to be the above-named person who signed the foregoing instrument.
WITNESS my hand and official seal
(Notary signature)
(seal) My commission expires:
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signature
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signature
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