Selective Service Registration Verification Form

Name of Financial Aid Applicant (Please print):

RETURN TO:

Last

First

Middle Initial

Financial Aid Office

Student ID#: _____________________________________________________

8045 E. Chapman Ave., Rm. E-104

Orange, CA 92869-4512 (714) 628-4876

SELECTIVE SERVICE REGISTRATION VERIFICATION

In order to receive Federal Student Aid, you must be registered with the Selective Service if you are a male who is 18 years old or

more and born after December 31, 1959. Because the processor of your Free Application for Federal Student Aid (FAFSA) did not

confirm that you registered with U. S. Selective Service System, you must now clear this up with the Santiago Canyon College (SCC)

Financial Aid Office (FAO) before your student aid can be processed.

CHECK THE ONE THAT APPLIES TO YOU AND PROVIDE PROOF OF SELECTIVE SERVICE REGISTRATION:

If you have not registered and want the Department of Education-(FAO) to register you with the Selective Service System by



making a correction to your FAFSA to include “Register me” to the registration question, please select this option. If you are

not yet 18, you will be registered by your 18

birthday. Once the answer on the FAFSA is corrected to “yes”, you may be

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awarded financial aid programs.

If you would like to register yourself, using the Selective Service System, you may do so at the following website:

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.

If you are not yet 18, you will be registered by your 18

birthday. Please print the confirmation page from

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the Selective Service System. This document must include your Selective Service I.D. # and the date of registration. Once you

have registered with the Selective Service System, you may be awarded financial aid programs. For additional information

regarding registering for Selective Service, you may call the Selective Service System at 847-688-6888.

Exempt: I am female.

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Exempt: I was born before December 31, 1959.

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If you are registered, attach a photocopy of your Selective Service Registration Identification Card.

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If you do not have your Selective Service Identification Card, contact the Selective Service Office at

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847-688-6888, or at their Website:

to obtain your Selective Service I.D. #.

Enter your Selective Service I.D. #.________________________

I’m a Veteran who is 26 years of age or older and served on active duty in the armed forces, excluding reserve forces, National

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Guard or Delayed Entry pool. Attach a copy of the DD Form 214 “Certificate of Release of Discharge from Active Duty”.

I was 26 years of age or older when I entered the United States. Provide copies of your documentation, a copy of the I-94 card

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or the Alien registration card that indicates your date of entry to the United States.

If you are unable to provide any of the information requested above, please attach a Status Information Letter from the

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Selective Service Office. You can obtain this letter by going to the Selective Services website at

and clicking on

“Request a Status Information Letter,” or you can obtain this letter by requesting it at Selective Service System, P.O. Box

94638, Palatine, IL 60094-4638 or Phone (714) 1-847-688-6888. You will need to return it to the above address with a written

statement including an explanation of noncompliance.

Certification and Signature: The student whose information was reported on the FAFSA must sign and date. The person signing below

certifies that all of the information reported is complete and correct.

WARNING: If you purposely give false or misleading information, you may be fined, be sentenced to jail, or both.

Student’s Signature

Date

Print Student Name

Non-Discrimination Policy

The Rancho Santiago Community College District is committed to equal opportunity in educational programs, employment, and all access to institutional programs and activities. The District, and each individual who represents

the District, shall provide access to its services, classes, and programs without regard to national origin, religion, age, gender, gender identity, gender expression, race or ethnicity, color, medical condition, genetic information,

ancestry, sexual orientation, marital status, physical or mental disability, pregnancy, or military and veteran status, or because he or she is perceived to have one or more of the foregoing characteristics, or based on association

with a person or group with one or more of these actual or perceived characteristics. The Chancellor shall establish administrative procedures that ensure all members of the college community can present complaints regarding

alleged violations of this policy and have their complaints heard in accordance with the Title 5 regulations and those of other agencies that administer state and federal laws regarding nondiscrimination. No District funds shall

ever be used for membership, or for any participation involving financial payment or contribution on behalf of the District or any individual employed by or associated with it, to any private organization whose membership

practices are discriminatory on the basis of national origin, religion, age, gender, gender identity, gender expression, race, color, medical condition, genetic information, ancestry, sexual orientation, marital status, physical or

mental disability, pregnancy, or military and veteran status, or because he or she is perceived to have one or more of the foregoing characteristics, or because of his or her association with a person or group with one or more of

these actual or perceived characteristics. Inquiries regarding compliance and/or grievance procedures may be directed to: Rancho Santiago Community College District Title IX Officer and Section 504/ADA Coordinator John

Didion 2323 N. Broadway Santa Ana, CA 92706 Phone: (714) 480-7489

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