2020-2021 Selective Service
Registration Verification
SLSRV
MS
JC has received your 2020-2021 Student Aid Report (SAR). Selective Service has not been able to confirm your registration or
exemption status. Males from age 18 - 25 (including permanent residents and other eligible noncitizens) are required to register
with the Selective Service in order to receive financial aid funds. Please indicate which statement applies to you and return the form
to the Financial Aid Office.
Please check appropriate box and submit required documentation listed below:
I was born a female and not required to register for Selective Service.
I am 17 years of age and I understand when I am age eligible (18-25), I will register for Selective Services at www.sss.gov
I am registered with Selective Service. Attach a photocopy or screen print from the website verifying registration. If you do
not have a copy, you may visit
www.sss.gov or contact them at 1-847-688-6888.
I am a Veteran who is 26 years of age or older and served on active duty in the armed forces, excluding reserve forces,
National Guard, or Delayed Entry pool. Attach a copy of your 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 and did not register with Selective Service, provide
documentation showing date of entry to the United States. (eg…I-94, Visa, Passport, Application for Residency…)
I am unable to provide any of the information requested from the above list, please attach all items listed below to this
form, and submit the packet to our office.
1. A Status Information Letter from the Selective Service Office. You can obtain a Status Information
Letter by sending a written statement with an explanation of noncompliance to the following address:
Selective Service Office
P.O. Box 94638
Palatine, IL 60094-4638
Phone: 1-847-688-6888
2. A signed written explanation for reason for failure to register.
3. Supporting documentation to substantiate your explanation.
CERTIFICATION
I
/WE HEREBY CERTIFY THAT ALL INFORMATION REPORTED ON THIS FORM AND ANY ATTACHMENTS HERETO ARE TRUE, COMPLETE AND ACCURATE.
FALSE INFORMATION OR MISREPRESENTATION WILL BE CAUSE FOR DENIAL, REDUCTION, WITHDRAWAL, AND/OR REPAYMENT OF FINANCIAL AID.
________________________________________________________________ __________________________
Student’s Signature Date
For Office Use Only
Approved. Student has successfully documented extenuating circumstances that support the failure to register was not willful.
De
nied. Explanation and supporting documentation were not sufficient to demonstrate failure to register was not willful.
Com
mittee Comments: ___________________________________________________________________________________________________________________
2020-2021 SELECTIV
E SERVICE REGISTRATION VERIFICATION
STUDENT INFORMATION
Please PRINT clearly with black/blue ink
Mt. San Jacinto College Financial Aid Office
Website: https://msjc.edu/financialaid/
Virtual Lobby: https://msjc.edu/hub/
Telephone: (951) 487-3245
Email: Finaid@msjc.edu
click to sign
signature
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