Student Financial Aid and Scholarships
1704 Weeksville Road
Elizabeth City, NC 27909
Financial_aid@ecsu.edu
Fax: 252-335-3716 Phone: 252-335-3283
Identity and
Statement of
Educational
Purpose
2016-2017 School Year
Statement of Educational Purpose
This form must be completed and signed in the presence of either a Notary Public or an Elizabeth City State University
Financial Aid Adminstrator. Do NOT complete the form in advance. You must complete either #1 or #2 listed
below:
#1- Mail the following signed and notarized form along with a copy of a government issued photo identification
(ID) to the Office of Financial Aid & Scholarships. Only original copies can be accepted. No faxes accepted.
-
OR –
#2 - The student can bring this form, in person, to the Elizabeth City State University Office of Financial Aid &
Scholarships with original valid government-issued photo identification. Do not complete the form in advance of
seeing a Financial Aid Administrator.
I certify that I, ____________________________________ (Print Student’s Name) 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 to pay the cost of attending Elizabeth City State University for the 2016-2017 award
year.
Student Signature: ____________________________________________Date____________________________
Notary’s Certificate of Acknowledgement:
State of: ________________________________ County of:___________________________________
Date: ____________________________________
(Student Name)___________________________________ personally appeared before me (Notary’s name)
_____________________________________ and provided to me on the basis of satisfactory evidence of
identification (type of gov’t photo ID provided) ____________________________to be the above-named person
who signed this document.
Witness my hand and official seal:
Notary’s signature ___________________________Seal_________________________ __________
My commission expires on ___________________________________
Office Use Only:
Signature of Institutional Official: __________________________________
Type of Government Issued ID Received: ___________________________
Government Issued ID Received Date: _____________________________
Rev 2/17/16
STATE16