Verification Worksheet − V4
North Central State College
Financial Aid Office
2016-2017
This form must be returned to the Financial Aid Office within 60 days.
Name (print) _________________________________________
NCSC I.D. ______________________
High School/GED Verification
To be eligible for Federal student aid, you must be either a high school graduate or GED recipient, and
you must provide specified documentation to verify it. If you are still in high school, provide
documentation to the College’s ADMISSIONS office as soon as possible after graduation.
Documentation is not required if the College currently has a copy.
I, (print your name in dark ink)_________________________________, graduated/will graduate from a/an:
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state-recognized public or private high school
Required documentation: final transcript showing date of graduation
approved home school program
Required documentation: final transcript showing date of graduation
General Educational Development (GED) program
Required documentation: official certificate or official score report
None of the above – provide explanation ____________________________________________
______________________________________________________________________________
Student signature____________________________________
Date_______________________
The following statement must be completed in person at the NC State Financial Aid Office (FAO).
If you cannot come in person to the FAO, do not complete this statement.
Instead, complete the statement on the reverse of this form in front of a Notary Public.
Statement of Educational Purpose
and Documentation of Identity
When completing this form, you must present currently valid government-issued photo identification
(ID), such as, but not limited to, your driver’s license, other state-issued ID, or passport.
I certify that I, (print your 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 and to pay the cost of attending North Central
State College for 2016-2017.
Student signature________________________________________ Date ____________________
Financial Aid Officer _____________________________________ Date____________________
143 Byron Kee Hall ✦ 2441 Kenwood Circle • Mansfield, Ohio 44906 ✦ 419-755-4899 (voice) • 419-755-4729 (fax)
[email protected] ✦ http://www.ncstatecollege.edu/cms/financial-aid.html
V4
Complete the other side of this form first.
Do NOT complete the following statement if you will complete the statement on the reverse of this form.
Statement of Educational Purpose
and Documentation of Identity
This must be signed before a Notary Public.
When completed, return this form to the NC State Financial Aid Office. This form may not be faxed or
e-mailed.
When completing this form, you must present the valid government-issued photo identification (ID) that
is acknowledged in the notary statement below, such as, but not limited to, your driver’s license, other
state-issued ID, or passport.
I certify that I, (print your 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 and to pay the cost of attending North Central
State College for 2016-2017.
________________________________
____________________
_____________________
Student Signature
Date
NCSC I.D. or SS#
Notary’s Certificate of Acknowledgement
State of ______________________________ City/County of ____________________________
on ___________________________ , before me,_____________________________________,
(Date)
(Printed name of Notary)
personally appeared, __________________________________, and provided to me on basis of
(Printed name of attester)
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)