Financial Aid
937.328.6034 | | 570 East Leel Lane, Springfield, Ohio 45505
2020-2021 Proof of Citizenship
Your FAFSA indicated that your citizenship is not confirmed with the Social Security Administration
or Department of Homeland Security. Complete this form and submit with your citizenship
documentation to the Financial Aid Oce. NOTE: If you cannot submit the documentation to the
Financial Aid Oce, see Section D.
SECTION A: Student Information
Name____________________________________________ Student ID Number___________________
Street City State Zip
Home Phone __________________________________ Work Phone _____________________________
SECTION B: Eligibility
A student must be one of the following to be eligible to receive federal student aid:
A U.S. citizen or national;
A U.S. permanent resident or other eligible noncitizen;
A citizen of the Freely Associated State: the Federated States of Micronesia and the Republics
of Palau and the Marshall Islands. These students can only receive aid from some of the Federal
Student Aid programs.
Financial Aid
U.S. Citizenship Documentation:
A copy of your birth certificate showing
you were born in the U.S., including Puerto
Rico, Guam, the U.S. Virgin Islands, American
Samoa, Swains Island or the Northern
Mariana Islands.
A U.S. Passport, current or expired,
excluding a limited passport.
A copy of Form FS-240 (Consular Report of
Birth Abroad).
A copy of Form FS-545 (Certificate of birth
issued by a Foreign Service post).
A copy of DS-1350 (Certification of Report
of Birth).
A Certificate of Naturalization (N-550 or
N-570) issued by USCIS.
Eligible Noncitizens Documentation, includes,
but not limited to:
Permanent Resident Card (Form I-551 since
Resident Alien Card (Form I-551 before 1997).
Arrival/Departure Record (CBP Form I-94)
with the endorsement “Processed for I-551”.
Departure Record (Form I-94A) with the
endorsement “Processed for I-551”.
Refugees may have Form I-94 or I-94A with a
stamp showing admission.
Individuals granted asylum will have an I-94 or
I-94A with a stamp showing admission.
Ineligible Statuses:
Person’s with nonimmigrant visas, including
work visas, student, visitors and foreign
government ocials are not eligible for
FSA with a Form I-94 with the proper
Family unity status individuals.
Temporary residents.
Illegal aliens under the legalization (amnesty)
Students with “Temporary Protected Status”
stamped on their I-94.
Financial Aid
937.328.6034 | | 570 East Leel Lane, Springfield, Ohio 45505
SECTION C: Certification Statement
I certify that all of the information on this form and accompanying documents are true and complete
to the best of my knowledge. Furthermore, I arm that I have not knowingly or intentionally provided
any false or fraudulent documentation.
Student Signature ___________________________________________ Date_____________________
___________________________________________________________ Date_____________________
Parent Signature (if parent citizenship status documentation is required)
State of ______________________________________________________________________________
City/County of ________________________________________________________________________
On_____________________, before me, __________________________________________________,
(Date) (Notary’s name)
personally appeared, ___________________________________________________, and proved to me
(Printed name of signer)
on the basis of satisfactory evidence of identification ________________________________________
(Type of unexpired government-issued photo ID provided)
to be the above-named person who signed the foregoing instrument.
WITNESS my hand and ocial seal
(seal) _________________________________________________
(Notary signature)
My commission expires on _________________________