Page 1 of 2
OFFICE OF FINANCIAL AID
AND SCHOLARSHIPS
Check your myClackamas account for all financial aid correspondence and your Award Letter.
Secure submission of documents can be completed in person, by mail, or fax to:
Office of Financial Aid and Scholarships · Roger Rook Hall · 19600 Molalla Avenue, Oregon City, OR 97045
Phone: 503-594-6082 · Fax: 503-722-5864 · e-mail: finaid@clackamas.edu · www.clackamas.edu
03/02/20 Dp
FAC20V4
2020-2021 V4 – CUSTOM VERIFICATION
(Summer Term 2020 – Spring Term 2021)
Student Last Name Student First Name
Student ID# Date of Birth
A. High School Completion Status
Provide one of the following documents to indicate the student’s high school completion status when the
student begins college in 2020-2021:
A copy of the student’s high school diploma.
For students who completed secondary education in a foreign country, a copy of the “secondary school
leaving certificate” or other similar document.
A copy of the student’s final official high school transcript that shows the date when the diploma was
awarded.
A state certificate or transcript received by a student after the student passed a State-authorized
examination that the State recognizes as the equivalent of a high school diploma (GED test, HiSET,
TASC, or other State-authorized examination).
An academic transcript that indicates the student successfully completed at least a two-year program
that is acceptable for full credit toward a bachelor’s degree.
For a student who was homeschooled in a state where state law requires the student to obtain a
secondary school completion credential for homeschooling (other than a high school diploma or its
recognized equivalent), a copy of that credential.
For a student who was homeschooled in a state where state law does not require the student to obtain a
secondary school completion credential for homeschooling (other than a high school diploma or its
recognized equivalent), a transcript, or the equivalent, signed by the student's parent or guardian, that
lists the secondary school courses the student completed and includes a statement that the student
successfully completed a secondary school education in a homeschool setting.
A student who is unable to obtain the documentation listed above must contact the financial aid office.
NOTE: If there is a difference with your name, please submit documentation such as a marriage
license or court name change document.
Page 2 of 2
OFFICE OF FINANCIAL AID
AND SCHOLARSHIPS
Check your myClackamas account for all financial aid correspondence and your Award Letter.
Secure submission of documents can be completed in person, by mail, or fax to:
Office of Financial Aid and Scholarships · Roger Rook Hall · 19600 Molalla Avenue, Oregon City, OR 97045
Phone: 503-594-6082 · Fax: 503-722-5864 · e-mail: finaid@clackamas.edu · www.clackamas.edu
03/02/20 Dp
FAC20V4
B. Confirmation of Identity and Statement of Educational Purpose
DO NOT COMPLETE THIS FORM IN ADVANCE
This statement must be completed and signed in the presence of either a CCC Financial Aid
Administrator or a Notary Public. Present valid, unexpired government-issued photo identification (ID),
such as, but not limited to, a driver’s license, other state-issued ID, or passport.
STATEMENT OF EDUCATIONAL PURPOSE
I certify that I, _____________________________, am the individual signing this Statement of
(Print Student Name)
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 Clackamas Community College for
2020-2021.
___________________________________ ________________ _____________
Student Signature Date Student ID#
Important: This original form must be returned in person or by mail.
Federal Regulations do not allow us to accept electronic submissions.
IF SUBMITTING BY MAIL
Send this form with a photocopy of valid government-issued photo ID.
To be completed by Notary Public
State of:
City/County of:
This instrument was acknowledged before me on:
ID Type: (include clear photocopy of front and back)
Notary Signature:
(Notary Seal)
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