Identity and Statement of Educational Purpose
Due to the current national situation, the student DOES NOT need to appear in person to
complete this form. The student must complete and sign the form, and provide a true copy or
image of the allowable identification – front and back. If the identification has expired, the
student may submit the identification if the identification has expired March 1
st
, 2020 or later.
The student must appear in person at __________________________________________ to
(Name of Postsecondary Educational Institution)
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 student’s 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
_______________________________________ for 2019-2020.
(Name of Postsecondary Educational Institution)
_________________________________________ _____________
(Student’s Signature) (Date)
__________________
(Student’s ID Number)
WAYS TO SUBMIT THIS FORM
(1) Upload the form at www.virginiawestern.com by clicking ‘Contact Us,’ and then clicking the 24/7 Student Support icon.
Once you log in you can submit documents(2) Fax forms to 540-857-6208
♦
Phone: (855)874-6690
(Revised 04_2020)
