Section B: (Use section B if the student is unable to appear in person at
New River CTC. If returning paperwork in person, please use section A.)
Identity
If the student is unable to appear in person at New River Community and Technical 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) 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.
Statement of Educational Purpose
I certify that I ____________________________________ am the individual signing this Statement of
(Print Student’s 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 New River Community and Technical College for 2020-
2021.
_________________________________________ _______________
(Student’s Signature) (Date)
______________________
(Student’s ID Number)
Notary’s Certificate of Acknowledgement
STATE OF _____________________________ COUNTY OF _______________________________
On _________________, before me ____________________________________, personally appeared,
(Date) (Notary’s Name)
_________________________________________, and proved to me on the basis of satisfactory
(Printed name of signer)
evidence of identification ________________________________________________ to be the above
(Type of unexpired government-issued photo ID provided)
named person who signed the foregoing instrument.
(seal)
WITNESS my hand and official seal
Notary Signature: ___________________________________
Notary Printed Name: ________________________________
My Commission Expires: _____________________________
(Date)
(Revised 10-15-19)
WARNING: If you purposely
give false or misleading
information you may be
fined, be sentenced to jail,
or both.
WARNING: If you
purposely give false or
misleading information,
you may be fined, sent to
prison, or both.
click to sign
signature
click to edit
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