2017
--
2018
State
me
nt of Educational P
ur
pose
Student ID
_________________________________________________________ ______________________________________
Last Name
Fi
rst Name
The student must appear in person at the Pasadena City College Office of Financial Aid to verify his or her identity by
presenting an unexpired 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 by the institution with
the date it was received and reviewed, and the name of the official at the institution authorized to receive and review the student’s
ID.
In addition, the student must sign, in the presence of the institutional official, the Statement of Educational Purpose provided
below.
If the student is unable to appear in person at the PCC Office of Financial Aid to verify his or her identity, the student must
provide to the Institution:
•
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
•
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 (To be signed in person at the Pasadena City College Office of Financial Aid
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 PCC for the 2017-2018 academic year.
Certification and Signature: I hereby certify that all information reported on this form is true, complete, and accurate. I
understand that false statements and/or misrepresentations will result in denial, reduction, withdrawal, and/or
repayment of aid d
i
sbursed
.
__________________________________________________________________________ ___________________
Student’s Signature
Date
__________________________________________________________________________ ___________________
Witnessed By
Date
Notary’s Certification of Acknowledgment (Only to be completed if unable to sign in Person
)
State of
City/County of
On
,
Date
before me,
personally appeared
Notary’s Name Printed Name of Signer
And proved to me on the basis of satisfactory evidence of identification,
to be the above named
Type of Government Issued photo ID provided
person who signed the foregoing instrument.
Witness my hand and Official Seal
My Commission Expires on
Notary’s signature
Date
1570 East Colorado Blvd.L-114, Pasadena, California 91106
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2003
18IDEN
