Financial Aid Office, IWU National & Global 1900 West 50
th
Street Marion, IN 46953-9393 indwes.edu
800.621.8667 option 4 765.677.2516 765.677.2030 Fax IWUfinaid@indwes.edu
IDENTITY AND STATEMENT OF
STUDENT INFORMATION
________________________________________ ____ _______________________________________________
First Name M.I. Last Name
___________________ OR __________________ ______________________________________
FC19ISEP
Student ID Last 4 Digits of SSN Phone Number
TO BE SIGNED WITH NOTARY
If the student is unable to appear in person at Indiana Wesleyan University 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, 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.
Statement of Educational Purpose
I certify that I, __________________________________________________________________________, am the
Print Student’s Name
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 Indiana Wesleyan University
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 proved to me
Printed Name of Signer
on basis of satisfactory evidence of identification _____________________________________________________
Type of 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
MAIL this completed form AND a copy of the unexpired valid government-issued photo identification to the financial aid
office using the contact information listed below. Faxed or scanned/emailed forms are unacceptable.
