11/12/2020
N
AME ____________________________________ ID NUMBER _______________
IDENTITY
STATEMENT of EDUCATIONAL PURPOSE
S
tudent’s signature______________________________________
Date______
________
NOTARY’S CERTIFICATE OF ACKNOWLEDGEMENT
State of ________________________________ City/County of ____________________________________________________
On_____________________, before me, ________________________________________________________, personally appeared,
(date) (notary’s name)
____________________________________________, and proved to me on basis of satisfactory evidence of Identification
(printed name of signer)
____________________________________________________ to be the above-named person who signed the foregoing instrument.
(Type of unexpired valid government-issued photo ID provided)
W
ITNESS my hand and official seal: _____________________________________ My commission expires on _____________
(notary signature) (date)
SEAL
Mail to:
Andrews University
Office of Student Financial Services Phone:
269.471.3334
4150 Administration Drive Email: sfs@andrews.edu
Berrien Springs, MI 49104-0750 Web: www.andrews.edu/sfs
2021-2022 STATEMENT of EDUCATIONAL PURPOSE:
NOTARY
If the student is unable to appear in person at Andrews University to verify his or her identity, the student must provide 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, non-driver’s identification card, other state-issued ID, or passport; and the original notarized
Statement of Educational Purpose provided below. To be signed only in presence of Notary.
I certify that I ________________________________________ am the individual signing this Statement of Educational Purpose
(print student’s name)
and that the federal student financial assistance I may receive will only be used for educational purposes and to pay the cost of
attending Andrews University for 2021-2022.
DO NOT FAX OR SCAN.
ORIGINAL DOCUMENTS ONLY
