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) A copy of the u
nexpired valid government-issued photo identification (ID) that is acknowledged in the notary
s
tatement 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 clear
indication that the Statement of Educational Purpose was the document notarized.
Statement of Educational Purpose
I c
ertify that I
(Print Student’s Name)
______
_______________________ am the individual signing this Sta
tement 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
(Name of Postsecondary Educational Institution)
_____________________for 2020-2021.
____
_______
____________________________ ______________
(Student’s Signature) (Date)
____
__________________
(Student’s ID Number)
Notary’s Certificate of Acknowledgement
State of ____________________________________________________________________
City/County of _______________________________________________________________
On
(Date)
_________
____________, before me, _
________________________________________
(Notary’s name)
,
personally appeared,
(Printed name of signer)
_______________________________________
___, and provided to me
on basis of satisfactory evidence of identification ___
____________________________________
(Type of government-i
ssued photo ID provided)
to be the above-nam
ed person who signed the foregoing instrument.
W
ITNESS my hand and official seal
(seal)
______________________________________
(Notary signature)
My commission expires on _________________________
(Date)
Financial Aid Official Use – MUST BE COMPLETED AT TIME OF RECEIPT
The Financial Aid Official receiving documents MUST indicate date of receipt and his/her name on ALL
documents, including the copy of the UNEXPIRED government issued ID, received in support of this statement.
Date of Receipt of Documentation Name of Financial Aid Official Receiving
Documentation
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