l~NJCU
NEW JERSEY CITY UNIVERSITY
_________________________________ __________________ ___________________
FORM TYPE: CIT
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MY ATTACHMENTS
2020-2021 NOTARIZED CITIZENSHIP AFFIDAVIT
(To Be Signed in the Presence of a Notary)
I certify that I _____________________________________________ am the individual signing this statement
(Print Student’s Name)
I am providing a copy of my documents along with a copy of a valid government-issued photo
identification card bearing my portrait (or likeness). I certify that the attached document(s) and government-
issued photo identification are the true, exact, and complete copies of the originals issued to me.
NAME OF VALID PHOTO ID EXPIRATION DATE OF ISSUING AUTHORITY OF VALID
VAILD PHOT ID PHOTO ID
NAME OF CITIZENSHIP AND/OR EXPIRATION DATE (IF ANY) OF CITIZENSHIP
IMMIGRATION DOCUMENT(S) AND/OR IMMIGRATION DOCUMENT(S)
Notary’s Certificate of Acknowledgement
State of __________________________City/County of ___________________ On_____________________,
(Date)
before me, __________________________, personally appeared,____________________________________,
(Notary’s name) (Printed name of signer/student)
and proved to me on the basis of satisfactory evidence of identification to be the above-named person who
signed the foregoing instrument.
WITNESS my hand and official seal
(seal) ________________________________________
(Notary signature)
My commission expires on _________________________
(Date)
Certification and Signature
WARNING: If you purposely give false or misleading information, you may be fined, sent to prison, or both.
Student’s Signature (Required) GOTHIC ID# Date
OFFICE OF FINANCIAL AID
Hepburn Hall, Room 215| 2039 John F. Kennedy Boulevard | Jersey City, NJ 07305
Phone: (201) 200-3173| Fax: (201) 200-3181 | Email: financialaid@njcu.edu
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