Office of Student Financial Aid
Identity and Statement of Educational Purpose 2021-2022
(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 2021-2022.
(Student’s Signature) (Date)
You must submit this original notarized form and attach a copy of your valid government issued photograph identification.
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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
(seal)
(Notary signature)
My commission expires on
(Date)
UPDATED
Signature Date
N
ame and title
(FAXED COPIES ARE NOT ACCEPTED)
Mail completed form to:
North Carolina Agricultural and Technical State University
Office of Student Financial Aid
1601 E. Market Street
Greensboro, North Carolina 27411
