Selective Service Documentation Form - Purdue University
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1OFFICE OF FINANCIAL AID
Selective Service Documentation
STUDENT NAME: _____________________________________
DATE: ______________
Students who are required to register with the Selective Service must do so to be eligible for Federal Student Aid.
Selective Service was unable to confirm your registration status.
DIRECTIONS: Complete and return this form and required documentation listed in Section 1 to the Office of
Financial Aid if you are registered with Selective Service. If you are not required to register with Selective
Service, check all boxes in Section 2 which apply to you and return this form and required documentation to the
Office of Financial Aid.
Section 1: Provide the following documentation if you are registered with Selective Service:
I AM REQUIRED TO REGISTER WITH SELECTIVE SERVICE:
Provide one of the following documents to the Office of Financial.
1.
A copy of your Selective Service Registration Card.
2. A copy of your Selective Service registration acknowledgment (available after registration with Selective
Service at ).
3.
A copy of your DD214 – Member 4 Copy (Certificate of Release or Discharge from Active Duty).
Section 2: Complete this section if you are not required to register with Selective Service:
I AM NOT REQUIRED TO REGISTER WITH SELECTIVE SERVICE DUE TO ONE OF THE FOLLOWING:
I am on active duty in the armed services.
I had not reached my 18
birthday at the time I completed my FAFSA.
th
I was born before 1960.
I am a citizen of the Republic of Palau, the Republic of the Marshall Island, or the Federated States of
Micronesia.
I did not register before my 26
birthday; I have attached both items below to this form:
th
1.
A copy of my Selective Service Status Information Letter. Visit /fsmen.htm for
additional information about this letter or call (847) 688.6888.
2. A personal statement explaining why I did not register.
CERTIFICATION: (Provide required signature and PUID)
Sign and date this form certifying that the information provided is complete and correct.
Student Signature: ______________________________________ Date: __________________
PUID: ______________________________________________
Office Use Only – RRAAREQ: SELSER ___Status Indicator (R)
Westville Campus
Hammond Campus
1401 S. U.S. Hwy. 421 * Westville, IN 46391
2200 169th Street * Hammond, IN 46323
Toll-Free: 1-855-608-4600
(21 9) ) ) ) 989-2301 * FAX: (219) 989-2141
(219) 785-5460 * FAX: (219) 785-5653
website: pnw.edu
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