2020-2021 Identity/Statement of Educational Purpose Verification
Notarized By mail only (Only complete if you cannot visit the office in person)
A. Student Information (Required)
Name
Date of Birth
Student ID
Phone Number
Street Address
State and Zip
B. High School Completion (Required)
Please check the box that is applicable.
I have provided proof of high school completion to Durham Tech Student Information and
Records office (Examples: High School or GED diploma or official high school or GED
transcript sealed in an envelope.)
I have attached proof of high school or GED completion.
C. Statement of Educational Purpose (Required)
To Be Signed with Notary Public
If the student is unable to appear in person at Durham Technical Community College to verify his
or her identity, the student provides
(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.
I certify that I, (Print student 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 Durham Technical
Community College for the 2020-2021 school year.
Student Signature ____________________________________ Date ________________________
Student ID Number ___________________________________
Page 1 I Revised 03/14/2018
Notary Certificate of Acknowledgement
State of ___________________ City/County of __________________________________________
On (Date) __________________, before me (Notary Name) ______________________________________
personally appeared, (Print name of student) ________________________________________, 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 My commission expires on
Notary signature __________________________________ Date _______________________________
Certification and Signatures (Required)
NOTE: This must be hand-signed. Electronic signatures of any form is not permissible.
Each person signing below certifies that all of the information reported is complete and correct.
WARNING: If you purposely give false or misleading information, you may be fined, sent to
prison, or both.
Student Signature
Date
D. Mail this form and a copy of State Identification (Required)
Note this must be a non-expired government issued photo ID such as a Driver’s License or Passport.
Durham Technical Community College Student ID’s are not acceptable.
Please return this completed form to:
Durham Technical Community College
Financial Aid Office
1637 Lawson Street
Durham, NC 27703
Page 2 l Revised 03/14/2018
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