Return completed form to: Castleton University Financial & Registration Services 62 Alumni Drive Castleton, VT 05735 Phone: 802-468-6070 Fax: 802-468-5237

Identity and Statement of Educational Purpose (To Be Signed With Notary) Student Name_____________________________________________________ ID #_________________________ Date of Birth ______________________________________________________ If the student is unable to appear in person at Castleton University to verify his or her identity, the student must provide: (a) A copy of the unexpired valid government-issued photo identification (ID) that is acknowledged in the notary statement below, or that is presented to a notary, such as, but not limited to, a valid driver’s license, other state-issued ID, or passport; and (b) The original Statement of Educational Purpose (in English or Spanish), provided below, which must be notarized. If the notary statement appears on a separate page than the Statement of Educational Purpose, there must be a clear indication that the Statement of Educational Purpose was the document notarized.

Statement of Educational Purpose I certify that I _______________________________________ am the individual signing this Statement of (Print Student’s Name) 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 Castleton University for 2016-2017. ____________________________________________________ (Student’s Signature)

_______________________________ (Date)

____________________________________________________ (Student’s ID Number)

Declaracion de Proposito Educativo Certifico que yo, _____________________________________. soy el individuo que firma esta (Imprimir Nombre del Estudiante) Declaracion de Finalidad Educativa y que la ayuda financiera federal estudiantil que yo pueda recibir, solo sera utilizada para fines educativos y para pagar el costo de asistir a Castleton University para 2016-2017. ____________________________________________________ (Firma del Estudiante) ____________________________________________________ (Numero de Identificacion del Estudiante)

CFC16EDP

________________________________ (la Fecha)

Notary’s Certificate of Acknowledgement Notary’s certification may vary by State

State of ______________________________ City/County of ___________________________________________________________________________ On___________________________, before me, _______________________________________________, (Date) (Notary’s name) personally appeared, ___________________________________________________, and proved to me on (Printed name of signer) basis of satisfactory evidence of identification __________________________________________________ (Type of unexpired, valid government-issued photo ID provided) to be the above-named person who signed the foregoing instrument, the Identity and Statement of Educational Purpose, and he (she) thereupon duly acknowledged to me that he (she) executed the same to be his (her) free act and deed. WITNESS my hand and official seal (seal)

_______________________________________________________ (Notary signature)

My commission expires on _______________________________. (Date) Note to the Notary: If the wording on this Notary Certificate of Acknowledgement is not right for the state the act will occur, please attach a certificate with the wording appropriate for the state in question. **Please attach a copy of the identification used in the acknowledgement.

CFC16EDP