Fillable V4 2019-20 FAFSA VERIFICATION WORKSHEET (East Central College)

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V4 2019-20 FAFSA VERIFICATION WORKSHEET (East Central College)

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SUBMIT FORM TO: Financial Aid Office | finaid@eastcentral.edu | fax 636-583-6651 | call 636-584-6588 | 1964 Prairie Dell Road, Union, MO 63084
2019-20
FAFSA VERIFICATION WORKSHEET
V4
LAST NAME FIRST NAME STUDENT ID # SOCIAL SECURITY # DATE OF BIRTH PHONE NUMBER
Submit to the Financial Aid Office in-person, at your campus, or via the email, fax, or mailing address listed at the bottom of this page within 30 days after
notification. If more space is needed for any line item on this form, provide a separate page that includes the student's name and ID number at the top.
Certification & Signature:
EACH PERSON SIGNING
CERTIFIES THAT ALL OF THE
INFORMATION REPORTED
X_____________
STUDENT SIGNATURE
____
DATE
X_____________
PARENT SIGNATURE (if a dependent student)
____
DATE
IS COMPLETE & CORRECT
Warning: If you purposely give false or misleading information, you may be fined, be sentenced to jail, or both.
SUBMIT FORM TO: Financial Aid Office | finaid@eastcentral.edu | fax 636-583-6651 | call 636-584-6588 | 1964 Prairie Dell Road, Union, MO 63084
2019-20
FAFSA VERIFICATION WORKSHEET
V4
Identity and Statement of Educational Purpose
You, the student, must appear in person at East Central College to verify your 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. East Central College will maintain a copy of your photo ID that is annotated with the date it was received &
reviewed & the name of the official at the institution authorized to collect your ID. In addition, you must sign, in the
presence of the institutional official, the following Statement of Educational Purpose.
ONLY to be signed AT THE INSTITUTION or in the presence of a Notary Public
AUTHORIZED COLLEGE OFFICIAL: STUDENT:
Copy student unexpired valid government-issued photo ID AT THE
TIME of their signing the Statement & annotate that copy with your
name & the date, verifying student identity. You may place it below &
make a copy:
_____________________________________ __________________
AUTHORIZED OFFICIAL NAME DATE
Statement of Educational Purpose
I certify that I __________________________
(Print Student's Name)
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 East Central College
for 2019-2020.
______________________________________
(Student's Signature)
__________________ ___________________
(Date) REQUIRED: (Student's ID#)
If you're unable to be present at East Central College: Notary's Certificate of Acknowledgement (below)
If you, the student, are unable to appear in person at East Central College to verify your identity, you must provide:
(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 above, 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.
THIS STATEMENT & COPY OF ID MUST BE SUBMITTED TO EAST CENTRAL COLLEGE IN ORIGINAL PAPER FORM.
State of ____________________ City/County of________________________ On (date)__________________, before me,
(Notary's name) ___________________________________, personally appeared, (Printed name of signer)
______________________________, and proved to me on basis of satisfactory evidence of identification
___________________________________ to be the above-named person who signed the foregoing instrument.
(Type of unexpired government-issued photo ID provided)
WITNESS my hand and official seal
(seal) __________________________________
(Notary signature)
My commission expires on _________________
(Date)
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V4 2019-20 FAFSA VERIFICATION WORKSHEET (East Central College)

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Completed 26 July 2020

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