Instructions: fill out form, choose ‘print’ icon then ‘save as pdf’ and email form from your device to
Student Name: ________________________________ ID Number: ____________________________ Telephone Number: __________________
Mailing Address: __________________________________________________________ Email Address: ___________________________________
The student must appear in person at River Parishes Community College Financial Aid Office to verify his or her identity by presenting a valid
government-issued photo identification (ID), such as, but not limited to, a driver’s license, other state-issued ID, or passport. RPCC will maintain a
copy of the student’s photo ID that is annotated with the date it was received and the name of the official at the institution authorized to collect
the student’s ID. In addition, the student must sign, in the presence of the institutional official, the following:
PROOF OF HIGH SCHOOL COMPLETION: (Staff use only - Check which applies)
Proof of high school equivalency
Copy of final official high school transcript that shows the date when the diploma was awarded
Copy of GED
Copy of document received. Date received: _____________ Accepted by: ______________
Statement of Educational Purpose
I certify that I (Print Student’s Name) _____________________________ am the individual signing this 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 the college for the
current aid year.
_________________________________________ _______________________
(Student’s Signature) (Date)
_________________________________________ _______________________
(Staff Witness Initials) (Date)
B. BY MAIL (Originals required, fax not acceptable)
If the student is unable to appear in person at College Financial Aid Office to verify his or her identity, the student must provide both: (To Be
Signed With Notary)
(a) A copy of the valid government-issued 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 Statement of Educational Purpose provided below.
Notary’s Certificate of Acknowledgement
State of ________________________________________________________________________
City/County of __________________________________________________________________
On (Date)___________________, before me (Notary’s name), ___________________________
personally appeared (Printed name of signer) , _________________________________________,
and provided to me 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) _________________________
Office of Financial Aid & Scholarships
Gonzales-Westside-Reserve Campuses
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