UMGC Office of Financial Aid | 3501 University Boulevard East, Adelphi MD 20783 USA
Federal law requires men age 18 through 25 to register with the Selecve Service System. According to your
Free Applicaon for Federal Student Aid (FAFSA), the Department of Educaon was unable to verify your
Selecve Service registraon or exempon. You must resolve any conicts regarding your
Selecve Service status before being awarded Federal Student Aid.
Instrucons: Please complete all secons that pertain to your situaon. All students must complete Part D on page 2.
Part A – Selecve Service Registraon Conrmaon
I cerfy that I am registered. Please submit supporng documentaon including a copy of your registraon
acknowledgement card, your web cercaon, or Status Informaon Leer from the Selecve Service. To register
or request a Status Informaon Leer, go to www.sss.gov.
Part B – Selecve Service Exempon
If you are exempt from registering with Selecve Service, please select an excepon from below. Please follow all
instrucons associated with the exempon you select including subming addional 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: Official government-issued document
showing date of birth such as state ID card, driver’s license, passport, or birth certificate.
I am on active duty in the U.S. armed forces. (Does not apply to Reserve or Guard members unless currently
on Active Duty status.) Documentation Required: A copy of your Leave and Earning Statement (LES) for the
most recent month.
I was in the military. Documentaon Required: Please aach 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 Pacic Islands (Palau). Documentaon 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 I turned 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
26th birth-day, you must provide proof that you were not living in the U.S. 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-cizen who entered the US as lawful nonimmigrant on a valid visa and remained in the U.S. on
the terms of that visa unl aer I turned 26. Documentaon Required: For example, if you entered the United
States on an F-1 student visa and remained in that status unl your 26th birthday, you would need to provide
documentaon indicang that you were admied on an F-1 visa and aended school full-me as required. Ac-
ceptable documentaon for this situaon includes a copy of your I-20 form or a leer from the school(s) you
aended indicang your full-me aendance as a non-immigrant alien. The same requirement applies for all
non-immigrant statuses. Please note: If, at any me, your cizenship status changed before the age of 26, you
may have been required to register with Selecve Service. For example, if you were a male who became an
eligible non-cizen on your 23
rd
birthday and you were no longer on an F-1 student visa, you were required to
register at that me. If this scenario is representave of your situaon, please address your circumstance for
not registering in Part C.
FSELSR
Page 1 of 2
Form: Selective Service Verification
Student’s ID #: _ Student’s Name: _________________________________________
Please scan and submit this completed form at www.umgc.edu/help/submit-case.cfm.
UMGC Office of Financial Aid | 3501 University Boulevard East, Adelphi MD 20783 USA
Part D – Cercaon and Signature
By signing this form, I cerfy that all the informaon is complete and correct and I have included the required
documentaon. I understand that providing false or misleading informaon or documents is punishable by ne
or imprisonment and may make me liable for repayment of any funds received on the basis of the informaon
and documents I have provided. I understand that I may be asked to provide addional informaon during the
review of this request.
Student’s Signature __________________________________________________ Date __________________
(must be signed by hand, not typed)
Part C – Selecve Service Explanaon
I did not register with the Selecve Service System between the age of 18 and 25. I have aached my Status Informaon
Leer from the Selecve Service. (To request the Status Informaon Leer please download the form from www.sss.gov. )
In the secon below, please explain your reason for not registering with Selecve Service. Aach any addional documenta-
on that supports your explanaon.
FSELSR
Page 2 of 2
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