Ubfa 2014-2015 Selective Service Verification printable pdf download

2014-2015 Selective Service Verification

Return form to: Office of Financial Aid

University at Buffalo

232 Capen Hall Buffalo, NY 14260

Fax: 716-645-7760 Phone: 716-645-8232

Email:

UBFA@buffalo.edu

Scanning and emailing documents is not a secure form of transmission.

STUDENT INFORMATION:

Last Name: ___________________________________ First Name: ______________________ Middle I: ____ Person Number: __________

INSTRUCTIONS:

You must complete all items on this form. This form will not be processed if any items are left blank or illegible.

If clarification of your situation is necessary, additional information or documentation may be required.

Return this completed form to the address noted above.

SECTION A: Selective Service Documents

Check one of the following conditions below and complete the actions associated with your selection.

CONDITION

ACTIONS

I am required to register with Selective Service.

Attach one of the following documents to this form (include your name and

(Visit

for registration requirements.)

UB person number to the top-right corner)

A copy of your Selective Service Registration Card

A copy of your Selective Service Registration acknowledgement

(available after registration with Selective Service at ).

A copy of your DD214 (Member Request Copy 4) “Certificate

of Release or Discharged from Active Duty”

I did not register with Selective Service because I

Attach one of the following documents to this form (include your name and

entered the United States for the first time after

UB person number to the top-right corner):

my 26

birthday.

a. Proof of birth date on one of the following:

passport

birth certificate

U.S. driver’s license or state ID

b. Proof of immigration date into the U.S. from an entry date stamp

on the I-94 from or in the passport, or a letter from the USCIS

indicating the entry date

I did not register with Selective Service because I was

Attach a copy of a student visa form I-20, other valid U.S. passport visa stamp

a visa holder between the ages of 18-25 year old.

with expiration date (the dates must be from entry until after the male turned 26

years of age).

I was required to but did not register with Selective

Attach both of these items to this form:

Service before my 26th birthday.

a. A copy of your Selective Service Status Information Letter. Visit

/fsmen.htm

for additional information about this letter or call

847-688-6888

b. A personal statement explaining why you did not willingly or knowingly

I am not required to register with Selective Service

a. For all military; attach proof of military status (e.g. DD214, military ID, etc.).

b. I am not yet 18 years of age, attach one of the following:

passport

birth certificate

U.S. driver’s license or state ID

I am not required to register with Selective Service

Attach proof of citizenship of the Republic of Palau, the Republic of the

because I am a citizen of the Republic of Palau, the

Marshall Islands, or the Federated States of Micronesia

Republic of the Marshall Islands, or the Federated

States of Micronesia

SECTION B: Certification and Signature

I certify that all information provided in this document is true, complete and accurate to the best of my knowledge. I further understand that any false

statement or misrepresentation will be cause for denial, reduction, withdrawal, and/or repayment of financial aid. Also, purposely giving false or

misleading information on this worksheet may lead to fines, jail sentences, or both. I authorize the University at Buffalo to make any change(s) necessary

as a result of the updated information that I have provided. By signing this form, I certify that I have read and agree to the financial aid terms and

conditions outlined in the Step-by-Step Guide ( )

____________________________________________________

____________________________________

Student’s Signature

Date

3/2014 CAS