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 to the institution: (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 2017-2018. ____________________________________________________ (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 2017-2018.

____________________________________________________ (Firma del Estudiante) ____________________________________________________ (Numero de Identificacion del Estudiante)

CFC17EDP

________________________________ (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. I have notarized the signing of the Statement of Educational Purpose. 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.

CFC17EDP