450 North Avenue • Battle Creek, MI 49017-3397
269-965-4123 • FAX 269-966-4089
Selective Service Registration/Appeal
Student Name Student ID#
Men age 18 through 25 are required to register with the Selective Service System. This requirement covers men residing in
the United States who are U.S. citizens or non-citizens.
I am female and not required to register
You may register at www.sss.gov. Please print your conrmation page and attach it to this appeal form.
I have registered with Selective Service and my conrmation page is attached
In rare cases some men will be exempt from registration. Please indicate if you are exempt from registration by checking
the appropriate box below, and providing supporting documentation to our oce.
Currently or previously in the armed services or on active duty. (Attach DD214)
Born before 1960
Non-citizen who rst entered the U.S. after turning 26 years of age.
Non-citizen who entered the U.S. as a lawful nonimmigrant on a valid visa and remained in the U.S. on the terms of
that visa until after I turned 26.
Unable to register due to being hospitalized, incarcerated, or institutionalized between the ages of 18 and 26.
If you are not exempt from registration due to any of the above reasons then you must contact the Selective Service
Registration System and request a status Information Letter be sent to you. Provide a copy of this Status Information Letter
to our oce once you receive it. We will then determine your eligibility for nancial aid.
You can request a Status Information Letter from the Selective Service Agency at their website:
I certify that all of the information reported to qualify for Federal student aid is correct.
If you purposely give false/misleading information on this worksheet, you may be ned and/or sentenced to jail.
Student Signature: _______________________________ Date: ____________________