Verification of Identity/Educational Purpose99
You must appear in person at Las Positas College (LPC) to verify your 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. LPC will maintain a
copy of your photo ID that is annotated with the date it was received and the name of the official at the institution authorized to
collect the ID.
A. Student’s Information
______________________________________________________________ ___________________________________
Last Name First Name M.I. W ID Number
______________________________________________________________ ___________________________________
Street Address (include apt. no.) Date of Birth
______________________________________________________________ ___________________________________
City State Zip Code Phone Number (include area code)
B. Identity and Statement of Educational Purpose (Must be signed in person at Las Positas College)
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 Las Positas College for the 2019–2020 school year.
C. Certification and Signature
I hereby certify that the information I have provided is
true and correct. I have attached documentation as
requiered above.
7he student must sign and date this form in person at the Financial Aid Office.
____________________________________________ ___________________________
Student’s Signature Date
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Financial Aid Use Only
Identification Document copied/verified:
____ Driver’s License ____ DHS document
____ State ID ____ Military ID
____ U.S. Passport
_________________________________________________ _________________________________
Financial
Aid Signature Date
WARNING: If you purposely give false or misleading
information on this worksheet, you may be fined, be sentenced
to jail, or both.
