Fillable 2020 2021 Identity and Statement of Educational Purpose (Vance-Granville Community College)

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2020 2021 Identity and Statement of Educational Purpose (Vance-Granville Community College)

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2020– 2021 Identity and Statement of Educational Purpose
Financial Aid Office, P.O. Box 917, Henderson, NC 27536
Telephone: (252) 738-3280, Fax: (252) 738-3388, Email: fao@vgcc.edu
Student Name: __________________________________ VGCC Student ID#: ___________________
Identity and Statement of Educational Purpose - To Be Signed at the Institution
The student must appear in person at to verify
(Name of Postsecondary Educational Institution)
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.
n) Name of Postsecondary Educational Institutio
If the student is unable to appear in person at to verify
(
Identity and Statement of Educational Purpose - To Be Signed in the
Presence of a Notary
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.
1
2020-2021 Identity & Educational Purpose Revised Date: 06/08/2020/FAO
Vance-Granville Community College
Vance-Granville Community College
2020– 2021 Identity andStatementof Educational Purpose
Financial Aid Office, P.O. Box 917, Henderson, NC 27536
Telephone: (252) 738-3280, Fax: (252) 738-3388, Email: fao@vgcc.edu
Statement of Educational Purpose
I certify that I ______________________________________ am the individual signing this Statement
(Print Student’s Name)
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 for 2020-2021.
(Name of Postsecondary Educational Institution)
VGCC Student ID: ___________________________
Type of Government-Issued Photo ID Attached: __________________________________________________
Student Signature: ____________________________________________ Date: ______________________
(must be signed in the presence of Financial Aid/Notary)
Notary’s Certificate of Acknowledgement
Notary’s certification may vary by State
State of ___________________________________________________________________________________
City/County of ______________________________________________________________________________
On___________________________, before me, __________________________________________________,
(Date) (Notary’s name)
personally appeared, _________________________________________________________, and proved to me
(Printed name of signer)
on the basis of satisfactory evidence of identification ______________________________________________
(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
(Provide seal) ________________________________________________
(Notary signature)
My commission expires on __________________________
(Date)
Office Use Only
Attached Copy of Student’s Government-Issued Photo ID: ___________________________________________
FAO Signature: ________________________________________________ Date: ______________________
2
2020-2021 Identity & Educational Purpose Revised Date: 06/08/2020/FAO
Vance-Granville Community College
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2020 2021 Identity and Statement of Educational Purpose (Vance-Granville Community College)

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Completed 24 July 2020

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