Xavier University of Louisiana
Office of Student Financial Aid and Scholarships
1Drexel Drive ● Box 40A
New Orleans, LA 70125-1098
(504) 520-7835 ● FAX (504) 520-7906
Identity and Statement of Educational Purpose Form
Student’s Information
_____________________________ _________________________
Last name
First name
______
M.I.
_______________________
Student ID
STATEMENT OF EDUCATIONAL PURPOSE:
I certify that I, _____________________________________________, am the individual signing 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 Xavier University of Louisiana
for 2015 - 2016.
Student’s Signature: _______________________________________________
Date:
______________________________
Student’s ID #:
______________________________
You must present this form in person to Xavier University of Louisiana. When presenting this
form, you will be required to provide valid government-issued photo identification which will be
copied by an authorized staff member, and submitted along with this form to the Financial Aid office.
Acceptable photo identity includes, but is not limited to a driver’s license, non-driver’s license,
military identification or passport.
Notary’s Certification of Acknowledgement
This form is to be notarized ONLY if you are not presenting it in person.
State of ________________________________, City/County of ______________________________
On ___________________________, before me, __________________________________________
(Date)
(Notary’s name)
Personally appeared, ___________________________________________, and provided to me on
(Printed name of signer)
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)
Reviewer Use Only
Action/approval date_________________________
FAA Signature___________________________________
Title_______________________

approved

denied