Identity Statement of Educational Purpose

Identity Statement of Educational Purpose
(To Be Signed at the College)
Itawamba Community College
602 West Hill Street
Fulton, MS 38843
Phone: 662.862.8220
www.iccms.edu
The student must appear in person at the Itawamba Community College Financial Aid office to verify his or her identity by
presenting a valid government-issued photo identification (ID), such as, but not limited to, a driver’s license, other stateissued ID or passport. The institution will maintain a copy of the student’s photo ID that is annotated with the date it was
received and the name of the official at the College authorized to collect the student’s ID. In addition, the student must
sign, in the presence of the College Financial Aid official, the following:
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
__________________________________________________________ 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]
VALID MEANS NOT EXPIRED
ID Type: _______________________________________________________________________________________
ID Number: __________________________________________________Exp. ______________________________
FAA Signature:__________________________________________________Date:____________________________
Itawamba Community College does not discriminate on the basis of race, color, national origin, sex, disability or age in its programs and activities.
The following person has been designated to handle inquiries regarding the nondiscrimination policies:
Vice President of Student Services, 602 West Hill St, Fulton, MS 38843; 662.862.8271
Revised February 26, 2014