If the student is unable to appear in person at North Shore Community College to verify his or her identity,
the student must provide:
(a) A copy of the unexpired valid government-issued photo identification (ID) that is acknowledged in the notary statement
below or presented to a notary 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, 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 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 North Shore Community College for 2019-2020.
______________________________________________________________________________________________________________________________________________________
STUDENT’S SIGNATURE DATE
Notary’s Certificate of Acknowledgement
State of ___________________________________________________________________________________
City/County of _________________________________________________________________________________________ __________________________________________
On ________________________________________, before me, ___________________________________________________________________________________________
DATE NOTARY’S NAME
personally appeared, _______________________________________________________________________________________ , and provided to me on basis
PRINTED NAME OF SIGNER
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
SEAL
2019–2020
Identity and Statement of
Educational Purpose
Student Financial Services • 1 Ferncroft Road • Danvers, MA 01923-0840
978-762-4189 www.northshore.edu/paying/financial-services
sfs@northshore.edu
Required (please print) ISEPN
Student ID#
N 0 0
Last Name: _____________________________________
First Name: _____________________________________
To be signed with Notary
2/27/19
Your 2019-2020 Free Application for Federal Student Aid (FAFSA)
was selected for review in a process called verification. You are
required to complete this form in order to complete the review
process. The law says that before awarding Federal Student Aid,
we may ask you to confirm the information you and your parents
reported on your FAFSA and make any necessary changes.
