Office of Financial Aid and Scholarships
Secure submission of documents can be completed in personRU by mailRQO\
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: firstname.lastname@example.org · www.clackamas.edu
V5 Aggregate Verification Worksheet
DO NOT COMPLETE THIS SECTION IN ADVANCE
F. Identity and Statement of Educational Purpose (To be signed at the institution)
The student must appear in person at Clackamas Community College to 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.
G. 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 Clackamas Community College to verify his or her identity, the student
must provide to the institution:
(a) A copy of the unexpired valid government-issued photo identification (ID) (front and back) 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.
H. Statement of Educational Purpose
I certify that I ________________________________________ am the individual signing 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 Clackamas Community College for 2018-2019.
(Student’s Signature) (Date)
(Student’s ID Number)
I. Notary’s Certificate of Acknowledgement
State of _______________________________________ City/County of ___________________________________
On_____________________, before me, _____________________________________________, personally appeared,
(Date) (Notary’s name)
____________________________________________________, and provided to me on the basis of satisfactory
(Printed name of signer)
evidence of identification ______________________________________________ to be the above-named person who
(Type of unexpired government-issued photo ID provided)
signed the foregoing instrument.
WITNESS my hand and official seal
My commission expires on ______________________
This worksheet must be signed and dated to be valid. Electronic and/or digital signatures are not valid.
Student’s Name: ________________________________________________ CCC ID: _________________________