2020 - 2021
Student Name Student ID Phone Number
We have received the results of your Free Application for Federal Student Aid (FAFSA). Additional information is
needed to verify citizenship status.
Check the box which applies to you and provide one of the types of documentation listed.
I am a U.S. citizen
Acceptable citizenship documents: birth certificate, Certificate of Citizenship (N-560 or N-561), Certificate of Naturalization
(N-550 or N570), U.S. passport, Consular Report of Birth Abroad (Form FS-240), Certificate of birth issued by a foreign
service post (FS-545), or Certification of Report of Birth (DS-1350).
I am an eligible noncitizen
Common citizenship/immigration documents which are acceptable:
Permanent Resident – Permanent Resident Card or Resident Alien Card
Conditional Resident Alien – Forms I-551, I-94, I-94A
Arrival Departure Record (I-94) from the Department of Homeland Security showing the following:
Victim of Human Trafficking
Battered immigrants-qualified aliens
Other documents may be acceptable in certain circumstances. If you do not have any of the documents listed above, feel free
to contact our office for assistance or submit documents you have so that we may review them to determine whether or not
they meet requirements.
Name of Citizenship/ Immigration Documents Submitted
Expiration Date (if any) of Citizenship/ Immigration Documents
Certification and Signatures:
I certify the citizenship/immigration documents submitted with this statement are the true, exact, and complete copies of the
originals issued to me. I understand if I purposely give false or misleading information I may be fined, sentenced to jail, or both.
Return completed worksheet(s) to:
Caldwell Community College and Technical Institute
Office of Financial Aid
E-mail – firstname.lastname@example.org
Caldwell Campus – 2855 Hickory Blvd., Hudson, NC 28638 Watauga Campus – PO Box 3318, Boone, NC 28607
Fax: 828.726.2709 Fax: 828.297.1729
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