Updated 4/29/2019
2020-2021
Statement of Educational Purpose
Identity and Statement of Educational Purpose
(To Be Signed at the Institution
in the presence of
a Financial Aid Representative)
The student must appear in person at Klamath Community College (KCC) 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.
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 Klamath
Community College (KCC) for 20202021.
________________ _____________________________________ _________
(Student’s Signature) (Date)
____________________________ ____________________________
(Student’s ID Number) (Student’s SS Number)
Received by: ___________________________________ Date: __________________
Financial Aid Administrator (Print Name)
WARNING: If you purposely provide false or misleading information you may be fined, be sentenced to jail, or both.
For Financial Aid Office Use Only
click to sign
signature
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Updated 4/29/2019
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 Klamath Community College (KCC) 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
(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
Klamath
Community College (KCC)
for 20202021.
______________________________________________________
(Student’s Signature) (Date)
______________________
(Student’s ID Number)
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
(seal) ________________________________________
(Notary signature)
My commission expires on _________________________
(Date
WARNING: If you purposely provide false or misleading information you may be fined, be sentenced to jail, or both.
click to sign
signature
click to edit
click to sign
signature
click to edit
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