Xavier University of Louisiana Office of Student Financial Aid and Scholarships
1 Drexel Drive Box 40
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 2016 - 2017.
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 _________________________
(Notary Signature)
My commission expires on __________________________________.
(Date)
_________________
(Seal)
Reviewer Use Only
Action/approval date _______________________
FAA Signature _______________________________
Title ________________________________________
Approved
Denied