Student's name: ___ Student's ID: ___
B. Identity and Statement of Educational Purpose
INSTRUCTIONS: The student must appear in person at Kentucky State University (KSU) to verify his/her identity by presenting valid government-issued photo identification (ID), such as driver's license, other state-issued ID, or passport. If the student cannot appear at KSU in person, please have this form notarized.
I certify that I _____ am the individual signing this
(Print Student's Name)
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 Kentucky State University for 2025-2026.
___
(Student's Signature) (Date)
If the student is unable to appear in person at Kentucky State University to verify his or her identity, the student must provide:
State of ___ City/County of ___
On___, before me, ___, personally appeared, ___, and
(Date) (Notary’s name) (Printed name of Signer)
provided to me on basis of satisfactory evidence of identification,_____ to be
(Type of government-issued photo ID provided)
who signed the foregoing instrument.
WITNESS my hand and official seal _____ My commission expires on _____
(Notary signature) (Date) (Seal if available)
Office Use Only: Verification Group: ___ Date: ___ Init: ___ [] RRAAREQ Update [ ] RHACOMM Update
[ ] Identity confirmation Document: _____ [ ] Copy of Identification document attached
[ ] Signature/ Identity Witnessed by: ___ [ ] Original Notarized Document received on ___/___/___
Do not mail this worksheet to the U.S. Department of Education. Submit this worksheet to the financial aid administrator at your school. Kentucky State University Financial Aid office, 400 East Main St. ASB Suite 349, Frankfort, KY 40601 finaidmail@kysu.edu, Phone: (502) 597-5960, Fax: (502) 597-5950 You should make a copy of this worksheet for your records.