Office of Financial Aid Louisiana College
1140 College Drive LC Box 582 Pineville, La. 71359 Ph: 318-487-7386 •
Fax 318-487-7449 •
Last Name First Name MI Student ID Date of Birth
Read each section of this form carefully and follow the directions in the section that applies to you. Return this form to
the LC Office of Financial Aid. Your file cannot be processed further without this documentation.
1) I cert
ify that I am EXEMPT from registration with Selective Service as I am:
A male born before 1960
Under the age of 18
2) Male aged between 18 and 25
Persons in this group are required to be registered for Selective Service in order to be eligible for federal student
aid. If
you have already done so, you must submit a copy of your Selective Service registration card to the Office of
Financial Aid.
If you have not yet registered, you may either:
a) Login to FAFSA on the web ( and correct your FAFSA checking the “register me”
indicator for question #22. The federal processor will forward your information to Selective Service for registration.
b) Register yourself electronically at and forward your confirmation to the Financial Aid Office.
c) Complete a Selective Service registration form, available at your Post Office and submit a copy of your
registration card to the Financial Assistance and Scholarship Office when received. Your financial aid file cannot be
processed further until this documentation is received.
3) Male aged 26 and over
It is no longer possible for you to register with Selective Service. You must contact the Selective Service Agency at
1-847-688-6888 to request a “Status Information Letter”. For your convenience you can download the “Request for
Status Information Letter” form at
Selective Service will issue a Status Information Letter that will clarify your status with Selective Service. Please
submit a copy of the Status Information Letter to the Financial Assistance and Scholarship Office and an
explanation letter for your failure to register.
Certification and Signature
By signing below you are certifying that all of the information reported is complete and correct. WARNING:
If you purposely give false or misleading information, you may be fined, sent to prison, or both.
Student Signature Date