Instrucons Page 2: Check the box of the type of original document you are subming and list the expiraon
date next to the item if applicable. Please make a copy of the coordinang document in the box below.
I cerfy that I, ____________________________________________, am the individual signing this statement
(print full name)
and I am providing copies of my cizenship and/or immigraon documentaon and a separate valid government-
issued photo idencaon card bearing my portrait (or likeness). I cerfy that the aached documents and
government-issued photo idencaon are the true, exact, and complete copies of the originals issued to me.
Student’s Signature __________________________________________________ Date __________________
(must be signed by hand, not typed)
UMGC Office of Financial Aid | 3501 Univers
ity Boulevard East, Adelphi MD 20783 USA
□ United States Passport, Expiraon Date (if applicable) _________________________
□ Cercaon of Naturalizaon or Birth Cercate
□ Permanent Resident Card (I-551; Green Card), Expiraon Date (if applicable)______________________
□ U. S. Passport stamped “processed for I-551”
□ Arrival/Departure Record (I-94 or I-94A) stamped with “Processed for I-551”, Expiraon Date ________________
□ Arrival/Departure Record (I-94) with designaon of Refugee, Asylum Granted, Parolee, Cuban-Haian Entrant or
T-Visa holder, Expiraon Date (if applicable) ______________________
□ Other _________________________, Expiraon Date (if applicable) ___________________
FCITZN / FDHSDC
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