UMGC Office of Financial Aid | 3501 University Boulevard East, Adelphi MD 20783 USA
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Academic Year: 2019-2020 Form: Identy and Statement of Educaonal Purpose — Notary
Student’s ID #: _ Student’s Name: _____________________________________
This completed form must be submitted by mail to:
UMGC Office of Financial Aid, 3501 University Blvd. East, Adelphi MD 20783 USA
Instructions, Page 1: If the student is unable to appear in person at University of Maryland Global Campus to
verify his or her identity, the student must provide to the institution:
(a) A copy of the unexpired valid government-issued photo idencaon (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 Educaonal Purpose provided below, which must be notarized. If the notary
statement appears on a separate page than the Statement of Educaonal Purpose, there must be a clear
indicaon that the Statement of Educaonal Purpose was the document notarized.
Your 2019-2020 Free Application for Federal Student Aid (FAFSA) was selected for a process called “verification”,
in which UMGC is required to confirm the informatio
n you reported on the FAFSA. Accurate completion
of this form is required in order to verify and process your 2019-2020 financial aid application.
Statement of Educaonal Purpose
I cerfy that I, ______________________________________ , am the individual signing
(Printed Name of Student)
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 University of Maryland Global Campus for 2019-2020.
Student’s Signature: ___________________________________ Date: ______________
(must be signed by hand, not typed)
Student’s UMGC ID #:
Please connue to Page 2.
UMGC Office of Financial Aid | 3501 University Boulevard East, Adelphi MD 20783 USA
Instructions, Page 2: Copy one of the following original documents in the box below: valid non-expired U.S. driver’s
license, other state-issued ID, or passport. Please note: UMGC cannot accept Military ID card copies per Title 18,
U.S. Code, Part I, Chapter 33, Section 701. Therefore, they cannot be used to complete this requirement.
Please connue to Page 3.
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[IDENTIFICATION DOCUMENT]
UMGC Office of Financial Aid | 3501 University Boulevard East, Adelphi MD 20783 USA
Notary’s Cercate of Acknowledgement
State of _____________________________________________________________________
City/County of ________________________________________________________________
On_____________________, before me, _____________________________________________________________
(Date) (Notary’s printed name)
personally appeared, ___________________________________________, and proved to me
(Printed name of Student)
on the basis of sasfactory evidence of idencaon _________________________________
(Type of unexpired government-issued photo ID provided)
to be the above-named person who signed the foregoing instrument.
WITNESS my hand and ocial seal
_______________________________________________
(Notary’s signature)
My commission expires on _________________________
(Date)
[SEAL]
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