______________________________
_______________
Financial Aid Office
2019-2020 Identity and Statement of Educational Purpose
(To Be Signed at the Institution)
Student Name
Student ID #
Phone Number
The student must appear in person at Caldwell Community College and Technical Institute
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 students 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 this
(Print Student’s Name)
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 Caldwell Community
College and Technical Institute for 2019–2020.
Student’s Signature Date Student’s ID Number
VERIFICATION OF UNEXPIRED VALID GOVERNMENT ISSUED
ID Type of ID provided:
Driver’s License Non-Driving State ID Passport Other:
CCC&TI Authorized Official Signature Date
Please return this completed worksheet to:
Caldwell Campus
Watauga Campus
2855 Hickory Blvd.
P.O. Box 3318
Hudson, NC 28638
Boone, NC 28067
Fax: 828.726.2709
Fax: 828.297.1729
Email: finaid@cccti.edu
Email: finaid@cccti.edu
click to sign
signature
click to edit
click to sign
signature
click to edit
______________________________
_______________
Financial Aid Office
2019-2020 Identity and Statement of Educational Purpose
(To Be Signed in the Presence of a Notary)
Student Name
Student ID #
Phone Number
If the student is unable to appear in person at Caldwell Community College and Technical
Institute to verify his or her identity, the student must provide to the institution:
(a) A legible 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
(Print Student’s Name)
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 Caldwell Community
College and Technical Institute for 2019–2020.
Student’s Signature Date Student’s ID Number
Notary’s Certificate of Acknowledgement
State of _____________________________ City/County of ____________/______________
On this day, _____________________, before me,____________________________________,
personally appeared, __________________________________________, and proved to me 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 ________________________________________
(Notary signature)
(seal) My commission expires: __________________
Please return this completed worksheet and copy of Photo ID to:
Caldwell Campus Watauga Campus
2855 Hickory Blvd.
P.O. Box 3318
Hudson, NC 28638
Boone, NC 28067
Fax: 828.726.2709
Fax: 828.297.1729
Email: finaid@cccti.edu Email: finaid@cccti.edu
click to sign
signature
click to edit
click to sign
signature
click to edit
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