2014-2015 Identity and Statement of Educational Purpose

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.