Fillable Identity and Statement of Educational Purpose (To Be (Frank Phillips College)

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Identity and Statement of Educational Purpose (To Be (Frank Phillips College)

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2020-2021
Identity and Statement of Educational Purpose
(To Be Signed at the Institution)
The student must appear in person at Frank Phillips College 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.
Frank Phillips College Institutional Official _________________________________
OR
Identity and Statement of Educational Purpose
(To Be Signed in the Presence of a Notary)
If the student is unable to appear in person at
(Name of Postsecondary Educational Institution)
to verify his or her identity, the student must provide to the institution:
A copy of the unexpired valid government-issued photo identification (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 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
The document notarized.
Statement of Educational Purpose
I certify that I am the individual signing
(Print Student’s Name)
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
Frank Phillips College For 2020-2021 School Year.
(Name of Postsecondary Educational Institution)
(Student’s Signature) (Date)
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2020-2021
Texto de verificación requerida para 2020-2021
Verificación de Identidad y Declaración de Propósito Educativo (Para
ser firmadas en la institución)
El estudiante debe comparecer en persona en para
(Nombre de la institución educativa postsecundaria)
verificar su identidad mediante la presentación de una identificación con fotografía (ID) válida emitida por el
gobierno que no haya expirado, como una licencia de conducir, otro tipo de identificación emitida por el
estado o pasaporte, entre otros. La institución conservará una copia de la identificación con fotografía del
estudiante en la cual se anotará la fecha en la que se recibió y revisó, y el nombre del funcionario de la
institución autorizado a recibir y revisar las identificaciones de los estudiantes.
Además, el estudiante debe firmar, en presencia del funcionario de la institución, la Declaración de Propósito
Educativo proporcionada a continuación.
Verificación de Identidad y Declaración de Propósito Educativo (Para
ser firmadas en presencia de un notario)
Si el estudiante no es capaz de comparecer en persona en
(Nombre de la institución educativa postsecundaria) para
verificar su identidad, el mismo debe proporcionar a la institución:
(a) una copia de la de identificación con fotografía (ID) válida emitida por el gobierno que no haya expirado,
que se reconoce en la declaración del notario que aparece a continuación, o que se presenta ante un
notario, como una licencia de conducir, otro tipo de identificación emitida por el estado o pasaporte, entre
otros; y
(b) la Declaración de Propósito Educativo original proporcionada a continuación debe ser
notarizada. Si la declaración del notario aparece en una página separada de la Declaración
de Propósito Educativo, se debe indicar de manera clara que la Declaración de Propósito Educativo era el
documento notarizado.
Declaración de Propósito Educativo
Certifico que yo, , soy el individuo que firma esta [Imprimir
nombre del estudiante]
Declaración de Propósito Educativo, y que la ayuda financiera federal estudiantil que yo pueda
recibir sólo será utilizada para fines educativos y para pagar el costo de asistir a
para 2020–2021.
[Imprimir nombre de institución educativa postsecundaria]
_
[Firma del
estudiante]
[Fecha]
[Número de identificación del estudiant
e]
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signature
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2020-2021
Notary’s Certificate of Acknowledgement
Notary’s certification may vary by State
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)
Frank Phillips College is an equal opportunity education institution and employer. Its students and
employees are selected and/or assigned without regard to age, race, color, creed, sex, national origin,
or disability, consistent with Titles VI and VII of the Civil Rights Act of 1964, and Title IX of the Higher
Education Act amended in 1972, and Section 504 of the Rehabilitation Act of 1973. The compliance
coordinator for Title IX is Dr. Shannon Carroll (scarroll@fpctx.edu; 806-457-4200, ext. 732) and Section
504 is Becky Green (bgreen@fpctx.edu; 806-457-4200, ext. 777).
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Identity and Statement of Educational Purpose (To Be (Frank Phillips College)

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Completed 27 July 2020

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