Verification of Identity and Statement of Educational Purpose
A.
STUDENT INFORMATION
Last name First name M.I. UH ID Number
Phone Number Date of Birth
B.
IDENTITY AND STATEMENT OF EDUCATIONAL PURPOSE
(TO BE SIGNED WITH NOTARY, if you are not able to submit the document in person)
Instructions for completing in-person at postsecondary educational institutional:
1. Please present an unexpired valid government-issued photo identification (ID), such as but not limited to a driver's license, other state-issued
ID, or passport to the financial aid office.
Instructions for completing with Notary, if not able to go in-person:
1. A copy of the unexpired valid government-issued photo identification (ID) that is acknowledged in the notary statement below, such as but not
limited to a driver’s license, other state-issued ID, or passport; and
2. The original Statement of Educational Purpose provided below, which must be notarized.
3. The original document must be mailed/given to the Financial Aid Office. Faxed or emailed versions will not be accepted.
STATEMENT OF EDUCATIONAL PURPOSE (Must be signed in-person)
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 for _ academic year.
(Name of Postsecondary Educational Institution) (Ex. 2019 - 2020 academic year)
Signature (Electronic/digital signature will NOT be accepted.) Date UH ID Number
NOTARY’S CERTIFICATE OF ACKNOWLEDGEMENT
State of City/County of
On , before me,
(Date) (Notary’s name)
personally appeared, , and proved to me
(Printed name of signer)
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
(Seal)
(Notary’s Signature)
My commission expires on
RETURN THIS FORM ALONG WITH ANY OTHER REQUIRED DOCUMENTATION TO THE COMMUNITY COLLEGE CAMPUS THAT YOU WILL BE ATTENDING:
Hawaiʻi Community College
1175 Manono Street * Hilo, HI 96720
Honolulu Community College
874 Dillingham Boulevard * Honolulu, HI 96817
Kapiʻolani Community College
4303 Diamond Head Road * Honolulu, HI 96816
3-1901 Kaumualiʻi Highway * Lihuʻe, HI 96766
Leeward Community College
96-045 Ala Ike Street * Pearl City, HI 96782
University of Hawaiʻi Maui College
310 West Kaʻahumanu Ave * Kahului, HI 96732
Windward Community College
45-720 Keaʻahala Road * Kāneʻohe, HI 96744
The University is committed to a policy of nondiscrimination on the basis of race, sex, gender identity and expression, age, religion, color, national origin, ancestry, citizenship, disability, genetic
information, marital status, breastfeeding, income assignment for child support, arrest and court record (except as permissible under State law), sexual orientation, national guard absence, or status
as a covered veteran. UH Title IX Coordinators' names and contact information are available at: https://www.hawaii.edu/titleix/help/coordinator/ and UH 504 Coordinators’ names and contact
information are available at: https://www.hawaii.edu/offices/eeo/ada-504-coordinators/
FAO USE ONLY
Documents reviewed: FAO Signature:
Rev. 04/2020
