Verification Form Of Eligibility For Services (Page 2 of 2) in pdf

Verification Form Of Eligibility For Services Page 2

SECONDARY

Does not have to include Date of Birth

Verifier’s



Document Title

Expiration Date

Include Number if applicable

Initials

Driver License, Instruction Permit or ID Card issued by any other state

Arizona Certificate of Birth (Foreign Born)

US Military Dependent ID Card

US Armed Forces Driver License

US Department of Veterans Affairs Card

US Department of Justice Inmate ID Card

Social Security Card

Legal Guardian Certificate

Selective Service Card

W-2 Form

Concealed Weapons Permit

Medical Insurance ID Card (including AHCCCS ID card)

Professional License

Bank Card/Credit Card

Employee ID Badge (with photo)

School ID (with photo)

Marriage Certificate issued by any state, territory or possession of the US

Certified Letter of Identification for a Ward of the Court, issued by a court or government agency in the US

Driver’s license or government ID card issued by a foreign government authority

Foreign passport, current or expired

Notice of Approval I-797

Letter from Dept. of Homeland Security indicating the applicant is in process status

NOTE:

Applicants holding Student Visas (Form F-1) are not eligible

for services through state-funded Adult Education programs.

For Office Use Only

Name of Verifier (Please Print)

Signature of Verifier

Date _______/_______/_______

(beginning on page 53)

Document examples can be found at:

I:\AdultEd\Academic Support and Compliance\Forms‐Processes\AE Eligibility Verification Form\FY 15\EligibilityVerificationForm0914.docx

Revised 09/04/14

Verification Form Of Eligibility For Services Page 2