2014-2015 Identity and Statement of Educational Purpose (To Be Signed With Notary) If you are unable to appear in person at Des Moines Area Community College to verify your identity, you must provide: (a) A copy of a 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 (b) The original notarized Statement of Educational Purpose (in English or Spanish) provided below: Statement of Educational Purpose (To Be Signed in Presence of a Notary) I certify that I, ______________________________________, am the individual signing (Print Student’s Name) 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 Des Moines Area Community College for 2014-2015. ________________________________________________ (Student Signature) _________________ (Date) _______________________________________________ (Student DMACC ID Number) Declaración de Propósito Educativo Certifico que yo, __________________________, soy el individuo que firma esta [Imprimir Nombre del Estudiante] Declaración de Finalidad Educativa y que la ayuda financiera federal estudiantil que yo pueda recibir, sólo será utilizada para fines educativos y para pagar el costo de asistir a ____________________________________ para 2014–2015. [Imprimir Nombre de Institución Educativa Postsecundaria] _____________________________________________ [Firma del Estudiante] ________________________________ [Número de Identificación del Estudiante] ________________ [la Fecha] Notary’s Certificate of Acknowledgement State of ______________________________________________ City/County of _________________________________________ On _____________________________, before me, __________________________________ (Notary’s name) (Date) personally appeared _______________________________________ and proved to me on basis (Printed Name of signer) 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 Signature) My commission expires on ______________________________ (Date) ________________________________________________________________________________________________ This completed form must be mailed to: DMACC Financial Aid Office 2006 S. Ankeny Blvd. Ankeny, IA 50023 Fax, email, or copies cannot be accepted.