Financial Aid
937.328.6034 | financialaid@clarkstate.edu | 570 East Leel Lane, Springfield, Ohio 45505
1
2020-2021
Selective Service Verification
Federal law requires men age 18 through 25 to register with the Selective Service System. According
to your free Application for Federal Student Aid (FAFSA), the Department of Education was unable
to verify your Selective Service registration or exemption. You must resolve any conflicts regarding
your Selective Service status before being awarded Federal Student Aid.
SECTION A: Student Information
Name____________________________________________ Student ID Number___________________
Address
_____________________________________________________________________________________
Street City State Zip
Home Phone __________________________________ Work Phone _____________________________
SECTION B: Please complete all sections that pertain to your situation.
Part A – Selective Service Registration Confirmation
Please submit supporting documentation including a copy of your registration acknowledgement card,
your web certification, or Status Information Letter from the Selective Service. To register or request a
Status Information Letter, go to www.sss.gov.
Part B – Selective Service Exemption
If you are exempt from registering with Selective Service, please select an exception from below.
Please follow all instructions associated with the exemption you select including submitting additional
documents, if necessary.
I was born a female and therefore am not required to register.
I am a male who was born before 1960. Documentation Required: Ocial government-issued
document showing date of birth such as state ID card, drivers license, passport, or birth
certificate.
I am currently in the armed services on active duty. Please note: This does not apply to members
of the Reserves and National Guard enlistee who is on active duty for state or training purposes.
I was in the military. Documentation Required: Please attach a copy of your DD214.
I am a resident of the Federated States of Micronesia or the Marshall Islands or a permanent
resident of the Trust Territory of the Pacific Islands (Palau). Documentation Required: Please
provide proof of residency.
I was incarcerated, institutionalized, hospitalized or confined to home from age 18 through 25.
Documentation Required: Attach proof of each instance including dates.
I am a non-citizen male who entered the US after age 26. Documentation Required: Date of entry
stamp in passport, I-94 with date of entry stamp on it, or a letter from the U.S. Citizenship and
Immigration Services (USCIS) indicating the date you entered the United States. If you entered the
U.S. illegally after your 26
th
birthday, you must provide proof that you were not living in the U.S.
Financial Aid
FAC20SEL
Financial Aid
937.328.6034 | financialaid@clarkstate.edu | 570 East Leel Lane, Springfield, Ohio 45505
2
from age 18 through 25. Please note: Resident Alien Card (Green Card) is not valid as proof of the
date of entry to the United States.
I am/was a non-citizen who entered the US as lawful nonimmigrant on a valid visa and remained
in the U.S. on the terms of that visa until after I turned 26. Documentation Required: For example,
if you entered the United States on an F-1 student visa and remained in that status until your 26th
birthday, you would need to provide documentation indicating that you were admitted on an
F-1 visa and attended school full-time as required. Acceptable documentation for this situation
includes a copy of your I-20 form or a letter from the school(s) you attended indicating your full-
time attendance as a non-immigrant alien. The same requirement applies for all non-immigrant
statuses. Please note: If, at any time, your citizenship status changed before the age of 26, you
may have been required to register with Selective Service. For example, if you were a male who
became an eligible non-citizen on your 23rd birthday and you were no longer on an F-1 student
visa, you were required to register at that time. If this scenario is representative of your situation,
please address your circumstance for not registering in Part C.
Part C – Selective Service Explanation
I did not register with the Selective Service System between the age of 18 and 25. I have attached my
Status Information Letter from the Selective Service. (To request the Status Information Letter please
download the form from www.sss.gov.)
In the section below, please explain your reason for not registering with Selective Service. Attach any
additional documentation that supports your explanation.
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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 _____________________
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