US Citizenship and Immigration Status Verification Form

2020 - 2021 U.S. Citizenship/Immigration Status Verification Form

Office of Financial Aid

Student Name: _________________________________________________

Student ID: _______________________

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Provide a copy of documents proving you are a U.S. citizen or an eligible non-citizen. This may include: o U.S. Birth Certificate o U.S. Passport o Certificate of Naturalization o Permanent Resident Card o I-551 o I-94 o T-Visa o or other official documentation

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Provide a copy of a photo identification card. This should be non-expired and issued by the government.

List the documents attached in the spaces below.

Name of Valid Photo ID Issuing Authority Expiration Date

VALID PHOTO IDENTIFICATION

U.S. CITIZENSHIP DOCUMENTATION Name of U.S. Citizenship Document Expiration Date (if any) of Citizenship Document * U.S. IMMIGRATION DOCUMENTATION Name of Immigration Document(s) Expiration Date (if any) of Immigration Documents *If documents submitted are needed to establish a non-U.S. Citizen’s eligiblity for Federal Student Aid, this form must be signed in the presence of a notary public.

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SUBMIT TO THE OFFICE OF FINANCIAL AID

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Certification of True, Exact and Complete Copy of the Original Document I certify that I _____________________________ am the individual signing this statement.

(Print Student’s Name) I am providing a copy of my documents along with a copy of a valid government-issued photo identification card bearing my portrait (or likeness).

I certify that the attached documents and government issued photo identification are the true, exact, and complete copies of the originals issued to me. ________________________________________________________ (Student’s Signature)

_______________________ (Date)

______________________ (Student’s ID Number)

Notary’s Certificate of Acknowledgement State of ________________________________________________________________________ City/County of ___________________________________________________________________ On_____________________, before me,______________________________________________, (Date) (Notary’s name) personally appeared, ____________________________________________, and provided to me (Printed name of signer) on basis of 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 (seal)

________________________________________ (Notary signature) My commission expires on ______________________ (Date)

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SUBMIT TO THE OFFICE OF FINANCIAL AID

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