Fillable Form VLP Revised March 2022: VERIFICATION OF LAWFUL (Mississippi)

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Form VLP Revised March 2022: VERIFICATION OF LAWFUL (Mississippi)

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Office of Teaching and Leading
Division of Educator Licensure
Form VLP Revised March 2022
Page 1 of 4
VERIFICATION OF LAWFUL PRESENCE
Mississippi Department of Education
Office of Educator Licensure
(601) 359-3483
Mississippi Code Ann. §71-11-1 requires all agencies within the state of Mississippi to fully cooperate with
federal immigration authorities in the enforcement of federal immigration laws. Therefore, the Division of
Educator Licensure has amended the current licensure application process to include procedures for
verifying an applicant’s lawful presence in the United States.
Effective with applications received January 1, 2021 and thereafter, all Citizens of the United States are
required to submit appropriate documentation for verification once during their next most immediate
licensure application submission. Non-US citizens are required to submit appropriate documentation for
verification with each licensure application submission, or when their United States Citizenship and
Immigration Services documents expire, whichever comes first. Licensure application(s) shall not be
processed if the applicant fails to answer the request for documentation required for verification of lawful
presence in the United States.
Any initial or renewable license issued to an applicant who is not a United States citizen shall expire in
accordance with the appropriate validity date required by a particular license type but, shall not exceed the
expiration date of the applicant's authorized stay in the United States, whichever is the lesser period of time.
A change in a Non-US citizen’s lawful presence status will affect his/her ability to receive or continue to hold
a Mississippi educator license.
It shall be the responsibility of the prospective or practicing educator to obtain and provide the MDE with
required documentation regarding his/her United States citizenship or lawful presence status. Required
forms and additional information found therein, can be accessed via the following web link:
[https://www.mdek12.org/OEL/Forms].
Office of Teaching and Leading
Division of Educator Licensure
Form VLP Revised March 2022
Page 2 of 4
VERIFICATION OF LAWFUL PRESENCE
(Please use black ink or type)
Please print your legal name legibly in the spaces indicated.
Title Last Name
☐Mr. ☐Ms. ☐Dr. _______________________________________________________
First Name Middle Name
___________________________________ ___________________________________
Social Security Number or Educator ID Number Date of Birth (MM/DD/YY)
___________________________________ ___________________________________
I am submitting the following required Verification of Lawful Presence (VLP) documentation:
☐This completed form; AND
☐The completed and notarized Affidavit (see important instructions at link below); AND
☐A copy of the ID used in completing the Affidavit and presented to the notary for validation.
These documents must be uploaded through the Correspondence section of your educator licensure
account at https://sso.mde.k12.ms.us/Login/Login.aspx. When uploading documents, please ensure
that all documents are uploaded as a PDF.
The Verification of Lawful Presence (VLP) Documentation has three (3) required
components. All three (3) documents must be submitted to fulfill the VLP requirement.
1. This form AND
2. The completed and notarized Affidavit AND
3. A copy of the valid ID used in completing the Affidavit. See instructions below to
ensure you use the correct ID for verifying lawful presence in the United States in
accordance with state and federal laws based on your citizenship status.
Failure to provide all three (3) documents
shall result in an application being placed
in pending status until received.
Office of Teaching and Leading
Division of Educator Licensure
Form VLP Revised March 2022
Page 3 of 4
Affidavit for Verification of Lawful Presence
By executing this affidavit under oath, as an applicant for a Mississippi Educator License, as from the
Mississippi Department of Education, the undersigned applicant verifies one of the following with
respect to application for a public benefit:
1) ☐I am a United States Citizen; OR
2) ☐I am a legal permanent resident of the United States; OR
3) ☐I am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act with
an alien number issued by the Department of Homeland Security or other federal immigration
agency. My alien number issued by the Department of Homeland Security or other immigration
agency is: ________________________________________.
The undersigned applicant also hereby verifies that he or she is 18 years of age or older and has provided at
least one secure and verifiable document with this affidavit.
The secure and verifiable document provided can be classified as:
_______________________________________________________________________.
In making the above representation under oath, I understand that any person who knowingly and willfully
makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation
of Mississippi Code Ann. § 97-7-10, and face criminal penalties as allowed by such criminal statute.
Executed in ___________________ (city), _______________________ (state).
_______________________________
Signature of Applicant
_______________________________
SUBSCRIBED AND SWORN Printed Name of Applicant
BEFORE ME ON THIS THE
_____ DAY OF ____________, 20 _____
NOTARY PUBLIC
My Commission Expires: ______________
________________________________
Signature of Notary
Office of Teaching and Leading
Division of Educator Licensure
Form VLP Revised March 2022
Page 4 of 4
List of Secure and Verifiable Documents for Confirmation of Lawful Presence
The following list of secure and verifiable documents contains documents that are verifiable for identification
purposes, and documents on this list may not necessarily be indicative of residency or immigration status.
☐ A valid, unexpired United States passport or passport card
☐ A valid, unexpired REAL ID driver’s license issued by one of the United States, the District of
Columbia, the Commonwealth of Puerto Rico, Guam, the Commonwealth of the Northern Marianas
Islands, the United States Virgin Island, American Samoa, or the Swain Islands, provided that it
contains a photograph of the bearer or lists sufficient identifying information regarding the bearer,
such as name, date of birth, gender, height, eye color, and address to enable the identification of
the bearer
☐ A valid, unexpired REAL ID identification card issued by one of the United States, the District of
Columbia, the Commonwealth of Puerto Rico, Guam, the Commonwealth of the Northern Marianas
Islands, the United States Virgin Island, American Samoa, or the Swain Islands, provided that it
contains a photograph of the bearer or lists sufficient identifying information regarding the bearer,
such as name, date of birth, gender, height, eye color, and address to enable the identification of
the bearer
☐ Certified birth certificate with stamp or raised seal issued by a U.S. government unit or U.S. territory
government office. (Note: Puerto Rican birth certificates are accepted only if issued on or after July
1, 2010)
☐ A tribal identification card of a federally recognized Native American tribe, provided that it contains
a photograph of the bearer or lists sufficient identifying information regarding the bearer, such as
name, date of birth, gender, height, eye color, and address to enable the identification of the bearer. A
listing of federally recognized Native American tribes may be found at:
http://www.bia.gov/WhoWeAre/BIA/OIS/TribalGovernmentServices/TribalDirectory/index.htm
☐ A valid, unexpired United States Permanent Resident Card issued by DHS or INS(I-551)
☐ A valid, unexpired Employment Authorization Document that contains a photograph of the bearer
issued by DHS
☐ A valid, unexpired Merchant Mariner Document or Merchant Mariner Credential issued by the
United States Coast Guard
☐ A Certificate of Citizenship issued by the United States Department of Citizenship and Immigration
Services (USCIS) (Form N-560 or Form N-561)
☐ A Certificate of Naturalization issued by the United States Department of Citizenship and Immigration
Services (USCIS) (Form N-550 or Form N-570)
☐ An expired immigration document along with Form I-797(Notice of Action) showing that new
documents have been applied for
In addition to the documents listed herein, if, in administering a public benefit or program, an agency is
required by federal law to accept a document or other form of identification for proof of or documentation of
identity, that document or other form of identification will be deemed a secure and verifiable document solely
for that particular program or administration of that particular public benefit.
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Form VLP Revised March 2022: VERIFICATION OF LAWFUL (Mississippi)

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Completed 13 May 2022

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