Verification Form Of Eligibility For Services

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ARIZONA ADULT EDUCATION SERVICES
VERIFICATION OF ELIGIBILITY FOR SERVICES
“I verify that I am eligible to attend Arizona Adult Education classes in accordance with Arizona Revised Statute 15-232. By
signing below, I represent that the information I have provided in this declaration is true and correct and that any document(s) I
present are genuine. I understand that false or misleading information or documents related to this declaration may subject me to
expulsion from the Program as well as other legal sanctions.”
Print Applicant’s LEGAL Name
Date of Birth _______/________/________
Applicant’s Signature
Today’s Date_______/________/________
A C C E P T A B L E
D O C U M E N T S
All documents must be originals or copies certified by the issuing agency
IMPORTANT:
PREFERRED
Only 1 of the following is needed. It must include a clear photo AND Date of Birth of the applicant AND be unexpired.
Verifier’s
Document Title
Expiration Date
Include Number if applicable
Initials
Arizona ☐Driver License ☐Instruction Permit or ☐Identification Card (please check one)
/
/
Enhanced Driver License or ID Card issued by another state, territory or possession of the US
/
/
US Passport or Passport Card
/
/
Permanent Resident Card/Resident Alien Card, I-551
/
/
US Military ID Card (active duty, reserve and retired)
/
/
If applicant is not presenting a PREFERRED Document, the following criteria apply: Select either:
(a) Applicant needs two documents listed below. One must have a clear photo of you AND one must be listed in the Primary category.
OR
(b) Applicant needs three documents if none of them have clear photos of applicant AND one must be listed in the Primary category.
PRIMARY
MUST include Date of Birth
Verifier’s
Document Title
Expiration Date
Include Number if applicable
Initials
Birth Certificate issued by any state, territory or possession of the US.
/
/
US Certificate of Birth Abroad or Delayed Birth Certificate
/
/
1-94 Form presented without passport
/
/
US Citizenship and Immigration Services, Refugee Travel Document I-571
/
/
US Certificate of Naturalization or Certificate of Citizenship
/
/
US Citizen ID Card I-197 or I-179
/
/
/
/
Tribal Certificate of Indian Blood ☐ Photo ☐ No Photo
Tribal or Bureau of Indian Affairs Affidavit of Birth
/
/
US Military DD-214
/
/
Affidavit of Identification (with photo & within 15 days of issue) from Arizona Department of Corrections
/
/
Released Offender ID (with photo) from Arizona Department of Corrections
/
/
ALPHA Program/Community Re-Entry ID from the Maricopa County Sheriff’s Office
/
/
Terms and Conditions of Probation or Parole document issued by the Court
/
/
Sentencing document placing the individual on probation or parole and issued by the Court
/
/
Unexpired Fiancée Visa (K-1)
/
/
Unexpired Non-immigrant Visa (K-3, K-4)
/
/
Individual Fee Register Receipt (Form G-711) that shows that the person has filed an application for a
/
/
New Naturalization or Citizenship Paper (Form N-565)
Grant Letter from the US Citizenship and Immigration Services Asylum Office
/
/
Order of an immigration judge granting asylum
/
/

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