* This form must be submitted by the priority deadline to ensure a determination of eligibility before the Fee Due Date. Students may still apply
for aid after the priority deadlines, but EFSC cannot guarantee that late submissions will be notified of aid eligibility prior to the Fee Due Date.
01/30/19
20SEL
FA Eligibility
2019-20 Selective Service Form
The Selective Service System has not confirmed your registration or exemption status. You must provide Eastern Florida
State College verification of your selective service registration status to determine eligibility for federal student aid.
Priority Deadlines*: Fall 2019 07/18/19 | Spring 2020 11/25/19 | Summer 2020 04/23/20
A. Student Information
B#
Last Name First Name M.I. Student ID
B. Selective Service Registration Status
Please select the appropriate status and provide any documentation listed.
I am required to register and have not yet done so. I understand that I am not eligible for federal student aid
until I register. Registration is available online at www.sss.gov or by completing a Selective Service registration
form at your local post office.
I am registered with Selective Service. My Selective Service Confirmation # is .
I am not registered, but I have received a status information letter from Selective Service.
Attach a copy of your status information letter. Visit www.sss.gov or call 1-847-688-6888 to obtain a
status information letter
. If your status information letter states that you were required to register but
failed to do so, please attach an explanation of why you did not register.
I am currently in the U.S. Armed Forces and on active duty (this exception does not apply to members of the
Reserve and National Guard who are not on active duty).
Attach a letter from your commanding officer documenting your active duty status.
I am a veteran of active duty in the U.S. Armed Forces (excluding National Guard and Reserves).
Attach a copy of your letter of discharge (DD-214). If you need to obtain a copy of your DD-214, request
it online at www.archives.gov/veterans/military-service-records/ from the National Archives Veteran
Service Records or by calling the Veterans Administration at 1-800-827-1000.
I was born before January 1, 1960.
I am not yet 18 years of age.
I was born female and not required to register.
Attach a copy of your Birth Certificate.
I am a citizen of one of the following: Republic of Palau, Republic of the Marshall Islands, or the Federated States
of Micronesia.
I am or was a noncitizen who first entered the U.S. after I turned 26 and I am not required to register.
Attach documentation of your immigration entry date into the U.S. from ONE of the following:
I-94 form
Dated passport immigration stamp entry documenting when you immigrated to the U.S.
Letter from the U.S. Citizenship and Immigration Services (USCIS) indicating your entry date
EFSC Office of Financial Aid
www.easternflorida.edu/go/aid | (321) 433-7339 | finaid@easternflorida.edu
2
I am or was a noncitizen who entered the U.S. as a lawful non-immigrant on a valid visa and remained in the U.S.
on the terms of that visa until after I turned 26.
Attach documentation of Immigration entry date into the U.S. prior to age 26 from ONE of the
following:
A date stamp on your I-94 form
Dated passport immigration stamp entry documenting when you immigrated into the U.S.
Letter from the U.S. Citizenship and Immigration Services (USCIS) indicating entry into the U.S.
A student visa form (I-20) or other valid U.S. passport visa stamp with expiration date (dates must be
from entry date until age 26)
I was institutionalized or incarcerated for the entire period that I should have registered.
Attach documentation to verify.
C. Certification and Signature
By signing below I certify that all of the information reported is
complete and correct.
Student’s Original Signature (cannot be signed electronically) Date
D. Document Submission
You may submit this document by the following methods:
1. EFSC DOCUMENT DROPBOX (RECOMMENDED)
Print and complete this document (including the original signature), scan the document, and upload the
document via the Document Dropbox in myEFSC. Printers and scanners are available in EFSC’s open
computer labs and libraries.
2. IN PERSON
Submit your document in person at the Office of Financial Aid on any campus:
Cocoa
Building 11, Room 209
Monday through Thursday, 8 a.m. to 7 p.m.
Palm Bay
Building 1, Room 117
Monday through Thursday, 8 a.m. to 7 p.m.
Melbourne
Building 1, Room 137
Monday through Thursday, 8 a.m. to 7 p.m.
Titusville
Building 3, Room 125
Monday through Wednesday, 8 a.m. to 5:30 p.m.
Thursday, 8 a.m. to 7 p.m.
WARNING: If you purposely give false
or misleading information, you may be
fined, sent to prison, or both.
EFSC Office of Financial Aid
www.easternflorida.edu/go/aid | (321) 433-7339 | finaid@easternflorida.edu
3
3. BY MAIL
Mail your document to the Office of Financial Aid on any campus:
Cocoa
Eastern Florida State College
Office of Financial Aid, C11-209
1519 Clearlake Road
Cocoa, FL 32922
Palm Bay
Eastern Florida State College
Office of Financial Aid, PB1-117
250 Community College Parkway
Palm Bay, FL 32909
Melbourne
Eastern Florida State College
Office of Financial Aid, M1-137
3865 N. Wickham Road
Melbourne, FL 32935
Titusville
Eastern Florida State College
Office of Financial Aid, T3-125
1311 N. US 1
Titusville, FL 32976
QUESTIONS?
Financial Aid Specialists are available at the campus locations listed above, by phone at 321-433-7339, and via e-mail at
finaid@easternflorida.edu.
Eastern Florida State College is committed to equal access/equal opportunity in its programs, activities, and employment.
For additional information, visit Eastern Florida State College: easternflorida.edu/go/equity.
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