Citizenship Confirmation Form printable pdf download

2015– 2016

CITIZENSHIP CONFIRMATION FORM

We need more information to confirm your Citizenship status (see below). When we receive it, we

can continue to process your 2015-16 financial aid application. This document must be submitted

before your last date of attendance for the academic year (2015-16) to be considered for all available

financial aid.

To be eligible to receive federal student aid, a student must be:

A U.S. citizen (or U.S. National), OR

An eligible non-citizen, such as a U.S. permanent resident or a resident of certain Pacific

Islands, or as determined by the U.S. Department of Homeland Security (DHS).

To verify your U.S. Citizenship status, please BRING TO OUR OFFICE at least ONE

of the following documents:

1. _____ Birth certificate showing your U.S. citizenship (COPY OR ORIGINAL)

2. _____ U.S. passport issued to you (ORIGINAL ONLY)

3. _____ Certificate of Citizenship issued by the DHS to individuals who derive U.S. citizenship

through a parent (ORIGINAL ONLY)

4. _____ Certificate of Naturalization issued by the DHS through a federal or state court

(ORIGINAL ONLY)

ORIGINAL DOCUMENTS WILL BE RETURNED AFTER THEY ARE COPIED.

To verify your eligible Non-Citizenship status, please BRING TO OUR OFFICE THE ORIGINAL of

at least ONE of the following documents:

1. _____ Permanent Resident or Resident Alien Card (known as the Green Card), OR

2. _____ Foreign Passport (stamped “Processed for I-551” with expiration date), OR

3. _____ I-94 (stamped “Processed for I-551” with expiration date, or “Temporary Form I-551,”

with appropriate information filled in)

ORIGINAL DOCUMENTS WILL BE RETURNED AFTER THEY ARE COPIED.

Below are possible reasons that your citizenship is being questioned:

DHS could not confirm your statement that you are an eligible non-citizen because there

is a question about your Alien Registration Number.

DHS has not yet confirmed your statement that you are an eligible non-citizen.

DHS did not confirm your statement that you are an eligible non-citizen.

DHS did not confirm eligibility because additional information is needed.

Social Security Administration (SSA) did not confirm U.S. Citizenship.

SSA is unable to verify citizenship because there was no match on SSN, name, or date

of birth. SSA found no match for the reported.

PLEASE PRINT:

Student Name ___________________________

SSN XXX-XX-_________

ID# _______________

Student Signature ________________________ Date _______________

Phone Number ___________

I:DATAFORMS2015-2016 office forms_ Citizenship Confirmation.doc

Rev. 10/23/14

PS CODE: F162FB

Citizenship Confirmation Form