2020-2021 Identity and Statement of Educational
Purpose (Notary)
Federal Student Aid Programs
Student Information (please print):
_________________________________________________________ _____________________/_________________ ________________________
Last Name, First Name, Middle Initial Social Security# and Student ID (A Number) Date of Birth
________________________________________________________ _______________________________________________________________________
Address City State Zip
_________________________________________________________ _______________________________________________________________________
Phone Number (include area code) Email Address
If the student is unable to appear in person at Calhoun Community College to verify his or her identity, the student
must provide:
(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.
Statement of Educational Purpose
I certify that I, ____________________________________________________, am the individual signing
(Print Student’s Name)
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 Calhoun Community College for 2020-2021.
_______________________________________ ___________________________ _____________________
Student’s Signature Student’s ID (A Number) Date
Notary’s Certificate of Acknowledgement
State Of ________________________City/County of ______________________On________________, before me
(Date)
________________________________, personally appeared ______________________________________________and
(Notary’s name) (Printed name of signer)
proved 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)
Please note that processing may take 3 – 4 weeks after documents are received especially during peak processing.
… return to Financial Aid office located at either campus: MAIL THIS FORM TO ADDRESS BELOW… OR
Calhoun Community College
Office of Financial Aid
P.O. Box 2216
Decatur, AL 35609
Decatur Campus 6250
Hwy 31 North Tanner,
AL 35671
256-306-2628
Huntsville/Research Park Campus 102-B
Wynn Drive
Huntsville, AL 35805
256-306-2628
I have agreed to submit this application by electronic means. By signing this application electronically, I certify under
penalty of perjury and false swearing that my answers are correct and complete to the best of my knowledge.
I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature.
