Please Print and Use Ink DO NOT LEAVE ANY LINE ON THIS FORM BLANK
2019-2020 IDENTITY STATEMENT OF EDUCATIONAL
PURPOSE
STUDENT INFORMATION
Student Name: SSN/Banner I.D. #:
Your application was selected for review in a process called “Verification.” In this process, MSU Northern will be comparing information
from your application with your financial documents. The law says we have the right to ask you for this information before awarding Federal
aid. Complete this verification form and submit it to the MSU Northern Financial Aid Office as soon as possible, so your financial aid won’t
be delayed.
STUDENT’S IDENTITY STATEMENT OF EDUCATIONAL PURPOSE
1. STUDENTS:
Student appearing in person:
o A valid government-issued photo identification, including but not limited to a driver’s license, non-driver’s license, military
identification, or passport; and by signing this form you are certifying the federal financial received will only be used for
educational purposed to pay the cost of attending the institution for 2019-2020.
The student must appear in person at MSU Northern to verify his or her identity by presenting a 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 with the date it was received and the name of
the official at the institution authorized to collect the student’s ID.
In addition, the student must sign, in the presence of the institutional official, the following:
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 MSU Northern for 2019-
2020.
_________________________________________ _______________
(Student’s Signature) (Date)
Office Use Only:
____________________________________________ _______________
Signature of Employee Date
___________________________________________
Title
Student unable to appear in person:
o Must provide a copy of a valid government-issued photo identification, including but not limited to a driver’s license, non-
driver’s license, military identification, or passport; and the original of this form notarized and signed by the student which
certifies the federal financial aid received will only be used
If the student is unable to appear in person at MSU Northern 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 Purpose and that the federal
(Print Student’s Name)
student financial assistance I may receive will only be used for educational purposes and to pay the cost of attending MSU Northern for
2019-2020.
_________________________________________ _______________
(Student’s Signature) (Date)
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 of satisfactory evidence
(Printed name of signer)
of identification _______________________________________ be the above-named person who signed the foregoing instrument.
(Type of government-issued photo ID provided)
WITNESS my hand and official seal
(seal) ________________________________________
(Notary signature)
My commission expires on _________________________
(Date)
AUTHORIZATION
By signing this worksheet, we certify that all the information reported to qualify for Federal student aid is complete and correct.
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail or both.
Student’s Signature Date Spouse’s Signature Date
Father’s (Stepfather’s) Signature Date Mother’s (Stepmother’s) Signature Date
Return this form to: Financial Aid Office; MSU Northern; PO Box 7751; Havre, MT 59501
MSU Northern does not discriminate on the basis of race, color, national origin, age, sex, or disability.
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