Wharton County Junior College
Financial Aid Office
2019-2020 Statement of Educational Purpose- V4 & V5
Identity and Statement of Educational Purpose
Use BLACK/BLUE INK only
The student must appear in person at the Wharton County Junior College Financial Aid Office to verify his/her
identity by presenting a valid government issued photo identification (ID), such as, but not limited to, a driver’s
license, other state‐issued ID, or passport. Wharton County Junior College will maintain a copy of the student’s photo
ID that is annotated with the date it was received and the name of the Wharton County Junior College Financial Aid
Office staff member that collected the form and photo ID.
I certify that I _____________________________________ (print name) am the individual signing 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 Wharton County Junior College for 2019‐2020.
_______________________________________ ______________________________________ ________________
Signature of Student Student’s ID# or SS# Date
___________________________________________ ____________________________ ______________________
Signature of Staff member that collected form Form of ID Date collected
If the student is unable to appear in person, the student is required to provide the Wharton County Junior
College Financial Aid Office with the following:
(a) A copy of a valid government‐issued photo identification (driver’s license, non‐driver’s license, or passport); and
(b) This original notarized statement of educational purpose signed by the applicant. Copies, emails, and a fax
(facsimile) of this form cannot and will not be accepted.
I certify that I _________________________________ (print name) am the individual signing 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 Wharton County Junior College for 2019‐2020.
______________________________________ ______________________________________ ________________
Signature of Student Student’s ID# or SS# Date
Notary’s Certificate of Acknowledgement
State of ___________________________ City/County of ___________________________ On_____________________,
(Date)
before me, ______________________________________, personally appeared, ___________________________________,
(Notary’s name) (Printed name of signer)
and provided to me on basis of satisfactory evidence of identification ____________________________ to be the above-
(Type of government‐issued photo ID provided)
named person who signed the foregoing instrument.
WITNESS my hand and official ___________________________________________________
(seal) (Notary signature)
My commission expires on ____________________________
(Date)
09/2018
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signature
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click to sign
signature
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click to sign
signature
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