Notifications of nondiscrimination and contact information can be found at www.ccac.edu, search keywords “notifications of nondiscrimination.”
In order to complete the Verification process, you will need to appear in person at the Financial Aid Office at the campus in
which you are attending. You will also be required to present your valid government issued ID (such as a driver’s license,
military ID, passport, etc.) this verification worksheet, and proof of high school completion to the financial aid administrator.
Financial aid will need to validate the statement below at the time of submission by maintaining a copy of your photo ID and
by providing a signature and date. If you cannot appear in person to submit this worksheet, you will need to provide
a copy of your government issued ID and this worksheet notarized by a public notary
Statement of Educational Purpose
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 Community College of Allegheny County_ for 2019-2020.
Student’s Signature and Date
Financial Aid Administrator’s Signature and Date
IMPORTANT: You must also provide acceptable proof that you have completed high school. Please attach the necessary
documentation with this form. Proof of High School Completion may include:
A copy of your high school diploma
A copy of your final high school transcript which includes a completion date
A copy of your GED certificate or transcript
Alternative documentation, if the options listed above are not available (contact the Financial Aid Office for
clarification of acceptable alternative documentation)
FINANCIAL AID MUST MAKE A COPY OF THE STUDENT’S GOVERNMENT ISSUED ID AND KEEP WITH THIS FORM
Notary’s Certificate of Acknowledgement
State of _________________________
City/County of_________________
before me, ___________________________________
(Date)
personally appeared,__________________________
And provided to me on basis 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)
________________________
(Date commission expires)
2019-2020 Statement of Educational Purpose and Identity
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signature
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signature
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signature
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