Green Card Form - Miami University
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1
2Green Card
SECTION I – To be completed by the student
The Department of Homeland Security could not confirm your statement that you are an eligible non-citizen. The
student must appear in person at One Stop for Student Success Services in the Campus Avenue Building to verify his
or her identity by presenting ONE of the following documents.
your Arrival Departure Record (form I-94), or
your Alien Registration Receipt Card (form I-151C), or
your Permanent Resident Card or Resident Alien Card (form I-551)
SECTION II – Only complete if you are unable to present one of the above documents in person.
Section II must be completed by student and notary public on Page 2.
This form is for the collection of DHS or other U.S. citizenship/nationality documents from students unable
to present their documents in person. Original must be presented to notary.
I certify that I _____________________________ am the individual signing this statement, and I am providing
(Print Student Name)
original documents along with a copy of a valid government-issued photo identification card bearing my portrait.
I certify that the attached documents and government issued photo identification are the true, exact, and complete
copies of the originals issued to me.
List of document(s):
NAME OF VALID PHOTO ID
EXPIRATION DATE OF VALID PHOTO
ISSUING AUTHORITY OF VALID
ID
PHOTO ID
NAME OF CITIZENSHIP AND/OR IMMIGRATION
EXPIRATION DATE (IF ANY) OF CITIZENSHIP AND/OR
DOCUMENT(S)
IMMIGRATION DOCUMENT(S)
Page 1 of 2
Miami University - One Stop for Student Success Services - 301 S. Campus Ave. - Oxford, OH 45056
513-529-0001 - Email: OneStop@MiamiOH.edu - Fax: 513-529-8713 - Web: MiamiOH.edu/OneStop
GREENC
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