Identity and Statement of Educational Purpose (to be signed at the

Identity and Statement of Educational Purpose
(to be signed at the institution)
The student must appear in person at ______Whitworth University________________________ to
verify his or her identity by presenting a valid government-issued photo identification (I.D.), such as, but not
limited to, a driver’s license, another state-issued I.D., or a passport. The institution will maintain a copy of the
student’s photo I.D. 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 collect the student’s I.D.
In addition, the student must sign, in the presence of the institutional official, the following English or Spanish
statement:
Statement of Educational Purpose
I certify that I, ______________________________________, am the individual signing this
(Print student’s name.)
Statement of Educational Purpose and that the federal student financial assistance
I may receive will be used only for educational purposes and to pay the cost of attending
Whitworth University during academic year 2014-15.
_________________________________________ _______________
(Student’s signature)
(Date)
______________________
(Student’s I.D. 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
Whitworth University para ano academico 2014-15.
_____________________________________________
[Firma del estudiante]
________________
[La fecha]
________________________________
[Número de identificación del estudiante]
Whitworth Use Only:
PV as OTHER Track as F14OTHC
M:\forms\14forms\14Identity and Statement of Education Purpose
Must be signed in front of Advisor unless Notary section is used. Advisors-Report to FAAccess
Identity and Statement of Educational Purpose
(To Be Signed With Notary)
If the student is unable to appear in person at _____Whitworth University_________________
(Name of Postsecondary Educational Institution)
to verify his or her identity, the student must provide:
(a) A copy of the 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
I certify that I _____________________________ am the individual signing this
(Print Student’s Name)
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
____________Whitworth University________________________ for 2014-2015.
(Name of Postsecondary Educational Institution)
_________________________________________ _______________
(Student’s Signature)
(Date)
______________________
(Student’s 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]
________________
[la Fecha]
________________________________
[Número de Identificación del Estudiante]
Whitworth Use Only:
PV as OTHER Track as F14OTHC
M:\forms\14forms\14Identity and Statement of Education Purpose
Must be signed in front of Advisor unless Notary section is used. Advisors-Report to FAAccess
Sample of a Notary’s Certificate of Acknowledgement
Notary’s certification may vary by State
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 signature)
My commission expires on _________________________
(Date)
Whitworth Use Only:
PV as OTHER Track as F14OTHC
M:\forms\14forms\14Identity and Statement of Education Purpose
Must be signed in front of Advisor unless Notary section is used. Advisors-Report to FAAccess
Certification and Signature
(Independent Student)
Certification and Signature
Each person signing below certifies that all of the
information reported is complete and correct.
WARNING: If you purposely give false or
misleading information you may be fined,
be sentenced to jail, or both.
________________________________________ ________________________
Print Student’s Name
Student’s ID Number
________________________________________ ________________________
Student’s Signature (Required)
Date
________________________________________ ________________________
Spouse’s Signature (Optional)
Date
Whitworth Use Only:
PV as OTHER Track as F14OTHC
M:\forms\14forms\14Identity and Statement of Education Purpose
Must be signed in front of Advisor unless Notary section is used. Advisors-Report to FAAccess
Certifications and Signatures
(Dependent Student)
Certifications and Signatures
Each person signing below certifies that all of the
information reported is complete and correct.
The student and one parent whose information was
reported on the FAFSA must sign and date.
WARNING: If you purposely give false or
misleading information you may be fined,
be sentenced to jail, or both.
________________________________________ ________________________
Print Student’s Name
Student’s ID Number
________________________________________ ________________________
Student’s Signature
Date
________________________________________ ________________________
Parent’s Signature
Date
Whitworth Use Only:
PV as OTHER Track as F14OTHC
M:\forms\14forms\14Identity and Statement of Education Purpose
Must be signed in front of Advisor unless Notary section is used. Advisors-Report to FAAccess