Office of Student Financial Aid
Identity and Statement of Educational Purpose 2020-2021
(To Be Signed with Notary)
___________________________________________________________ Banner: XXX_______________________
Student Last Name Student First Name MI Last 6 digits only
If the student is unable to appear in person at North Carolina Agricultural and Technical State University to verify his or her identity,
the student must provide:
(a) A copy of the valid government-issued photo identification (ID) that is acknowledged in the notary statement below,
such as but not limited to a driver’s license, other state-issued ID, or passport; and
(b) The original notarized Statement of Educational Purpose provided below.
I certify that I ____________________________________________ am the individual signing this Statement of Educational
(Print Student’s Name)
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 North Carolina Agricultural and Technical State University for 2020-2021.
_________________________________________________ __________________________
(Student’s Signature) (Date)
You must submit this original notarized form and attach a copy of your valid government issued photograph identification.
Notary’s Certificate of Acknowledgement
State of ____________________________________________________________________________________
City/County of _______________________________________________________________________________
On________________________, before me, ______________________________________________________,
(Date) (Notary’s name)
personally appeared, __________________________________________________, and provided to me on basis
(Printed name of signer)
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 ___________________________________________________
(Notary signature)
My commission expires on _____________________________________
Reviewer Use Only:
Signature____________________________________________________________ Date__________________________
Name and title_________________________________________________________________________________________
Mail completed form to:
North Carolina Agricultural and Technical State University
Office of Student Financial Aid
1601 E. Market Street
Greensboro, North Carolina 27411
Telephone: 336-334-7973