Fillable 2020-2021 Identity and Statement of Educational Purpose (Washington State Community College)

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2020-2021 Identity and Statement of Educational Purpose (Washington State Community College)

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Office of Financial Aid
710 Colegate Drive, Marietta, OH 45750
Phone: 740.568.1908 Fax: 740.376.0257
E-mail: finaid@wscc.edu
2020-2021 Identity and Statement of Educational Purpose
(To Be Signed at the Institution)
Student Name: _________________________________ WSCC ID: _________________ DOB: _____/_____/__________
The student must appear in person at Washington State Community College 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.
Student’s Statement 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 Washington State Community College for
2020-2021.
___________________________________________________ ___________________
(Student’s Signature) (Date)
_________________________
(WSCC ID Number)
IF YOU ARE UNABLE TO SIGN THIS AT WASHINGTON STATE COMMUNITY COLLEGE,
YOU MUST USE THE FORM ON THE BACK OF THIS DOCUMENT
AND SIGN IN FRONT OF THE NOTARY PUBLIC.
Office Use Only
FAO Signature:_________________________________________________ Date:_______________________
Attached color copy of government-issued ID
Identity and Statement of Educational Purpose
(To Be Signed in the Presence of a Notary)
If the student is unable to appear in person at Washington State Community College 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. 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 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 Washington State Community College
for 2019-2020.
___________________________________________________ ___________________
(Student’s Signature) (Date)
_________________________
(WSCC ID Number)
Notary’s Certificate of Acknowledgement
State of ________________________________________________________________________
City/County of ___________________________________________________________________
On______________________, before me, ____________________________________________,
(Date) (Printed name of Notary)
personally appeared ____________________________________________ and proved to me on
(Printed name of signer)
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)
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2020-2021 Identity and Statement of Educational Purpose (Washington State Community College)

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Completed 26 July 2020

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