Verification Independent - Worksheet V4 - 2016-2017 Page 2

Identity Verification   a nd   S tatement   o f   E ducational   P urpose  

Do   n ot   c omplete   t his   p age   i n   a dvance.   Y ou   m ust   c omplete   a nd   s ign   t his   p age   I N   P ERSON   a t   t he   F inancial   A id   O ffice   a t   y our   c ollege  

Student’s   N ame:   _ ________________________________                                   S ocial   S ecurity   n umber________________  

You   h ave   b een   s elected   b y   t he   U .S.   D epartment   o f   E ducation   t o   v erify   y our   i dentity   a nd   e ducational   p lans.   Y ou   m ust   a ppear   i n  

person   a t   t he   F inancial   A id   O ffice   a t   y our   c ollege   a nd   p resent   a   p iece   o f   v alid   g overnment-­‐issued   i dentification   t o   a   f inancial   a id  

representative.   T he   r epresentative   w ill   r eview   a nd   c opy   t his   p iece   o f   i dentification   w hich   w ill   b e   m aintained   i n   y our   s tudent   f ile.  

 

 

Statement   o f   E ducational   P urpose  

I   c ertify   t hat   I ,         _ _____________________________  

                                                                                ( Print   N ame)  

am   t he   i ndividual   s igning   t his   S tatement   o f   E ducational   P urpose   a nd   t hat   t he   f ederal   s tudent   f inancial   a ssistance   I  

may   r eceive   w ill   o nly   b e   u sed   f or   e ducational   p urposes   a nd   t o   p ay   t he   c ost   o f   a ttending  

Loyola   U niversity   N ew   O rleans   f or   2 016-­‐2017.  

Student’s   S ignature:   _ __________________________________   D ate:   _ _________________________                

1.Proof of Identity

The   a bove-­‐named   s tudent   h as   p resented   v alid   g overnment-­‐issued   p hoto   i dentification   s uch   a s   a   s tate   d river’s  

license,   n on-­‐driver’s   l icense,   m ilitary   i dentification   o r   p assport   w hich   v erifies   h is   o r   h er   i dentity.  

FA Certifying Officer’s Signature ______________________________ Date Received ___________

2.Completion of High School or the Equivalent

The   a bove-­‐named   s tudent   h as   s ubmitted   a   f inal   h igh   s chool   t ranscript   o r   o ther   a cceptable   d ocumentation   t o   t he  

Scholarships   a nd   F inancial   A id   O ffice   t hat   s hows   e vidence   o f   g raduation   f rom   a n   a ccredited   h igh   s chool   o r  

educational   i nstitution,   s tate-­‐issued   g eneral   e ducation   e quivalency   ( GED),   o r   e vidence   o f   h ome   s chooling.  

FA   C ertifying   O fficer’s   S ignature

_________________________ Date Received ____________________

Student’s   S ignature:   _ __________________________________     D ate:   _ ____________________________