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Identity And Statement Of Educational Purpose Form - Truckee Meadows Community College

Financial Aid, Scholarships, Student Employment and Veterans Education Benefits

I D E N T I T Y A N D S T A T E M E N T O F E D U C A T I O N A L P U R P O S E

F o r 2 0 1 5 - 2 0 1 6 ( T o B e S i g n e d wi t h N o t a r y)

If the student is unable to appear in person at Truckee Meadows Community College to verify his or her identity, the

student must provide:

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

The original notarized Statement of Educational Purpose provided below.

•

S T A T E M E N T O F E D U C A T I O N A L P U R P O S E

I certify that I __________________________________ am the individual signing this Statement of Educational Purpose

Student's Name (Print)

and that the Federal student financial assistance I may receive will only be used for educational purposes and to pay the

cost of attending Truckee Meadows Community College for 2015–2016.

_____________________________________________________________________________

____________________________________________

Student's Signature

Date

_________________________________

NSHE ID

N O T A R Y ’ S C E R T I F I C A T E O F A C K N O W L E D G E M E N T

State of ____________________________________ City/County of _________________________________________

On_____________________, before me, ______________________________________ personally appeared,

Date

Notary's Name

____________________________________________, and proved to me on basis of satisfactory evidence of

Name of Signer (print)

identification ________________________________ to be the above-named person who signed the foregoing instrument.

Type of Government Issued Photo ID Provided

WITNESS my hand and official seal

__________________________________________________________________

~~~~~~~~~~~~~seal~~~~~~~~~~~~~

Notary's Signature

My commission expires on ___________________________

Date

For Office Use Only

Received by: ____________Date: ______________ Processed by: ______________ Date: _____________

Page 1 of 1; Identity and Statement of Educational Purpose-Notarized

Created: 2/24/2015; Rev: 3/5/2015

TMCC is an EEO/AA institution. See for more information.

Identity And Statement Of Educational Purpose Form - Truckee Meadows Community College