Fillable Kentucky Community & Technical College System - Request for Selective Service Reconsideration

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Kentucky Community & Technical College System - Request for Selective Service Reconsideration

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Request for
Selective Service Reconsideration
Your FAFSA results indicate you are not eligible for
federal financial aid because you are not registered with
Selective Service. To be eligible for federal aid, a male
must register with Selective Service within 30 days of
reaching his 18
th
birthday or by age 26. This application
is to request a review of your ineligibility.
No financial aid is available to you until you complete
and submit this Request for Selective Service
Reconsideration to the Financial Aid Office
Please put your student ID number on all forms
submitted to the Financial Aid Office.
Social Security Number
I certify that I am registered with Selective Service (attach a copy of your registration record from the Selective
Service website at www.sss.gov)
I certify that I am not required to register with Selective Service because (see attached chart):
I am female (Please either update your FAFSA response, or submit a copy of your driver’s license).
I have not reached my 18
th
birthday.
I was born before 1960.
I am in the armed services on active duty (NOTE: This does not apply to members of the Reserves or
National Guard who are not on active duty).
I entered the country after age 26 (provide your passport or entry documents with this form).
I did not register with Selective Service. You must complete a "Request for Status Information Letter" by
completing the attached form or requesting online at www.sss.gov. Provide the following items to the Financial
Aid Office:
Completed and signed Request for Selective Service Reconsideration form
Copy of your Status Information Letter
Letter detailing your failure to register
Supporting documentation provided with your Status Information Letter
Your documents will
be reviewed by the college and you will be notified of the decision. Incomplete
submissions will not be considered.
The decision of
the Financial Aid Office is final and cannot be appealed to the U.S. Department of Education.
I swear under penalty of perjury that all of the information contained in this application is true to the best of my knowledge.
I understand that providing false or misleading information in an attempt to obtain federal financial aid can result in a fine
of up to $10,000 and/or incarceration. I understand that failure to provide the required documentation will result in
denial of this application.
Student Signature: Date:
Student ID Number
Print Last Name
First
MI
Print Street Address
Print City
State
Zip
NOTE: With only a few exceptions, the registration requirement applies to all male U.S. citizens and male
immigrants residing in the United States who are 18 through 25 years of age.
Category
YES NO
All male U.S. citizens born after Dec. 31, 1959, who are 18 but not yet 26 years old, except as noted below:
Members of the Armed Forces on active duty (active duty for training does not constitute “active duty” for
registration purposes)
Cadets and Midshipmen at Service Academies or Coast Guard Academy
Cadets at the Merchant Marine Academy
Students in Ofcer Procurement Programs at the Citadel, North Georgia College and State University, Norwich
University, Virginia Military Institute, Texas A&M University, Virginia Polytechnic Institute and State University
ROTC Students
National Guardsmen and Reservists not on active duty / Civil Air Patrol members
Delayed Entry Program enlistees
Separatees from Active Military Service, separated for any reason before age 26
Men rejected for enlistment for any reason before age 26
Military Related
Immigrants**
Lawful non-immigrants on visas (e.g., diplomatic and consular personnel and families, foreign students,
tourists with unexpired Form I-94, or Border Crossing Document DSP-150)
Permanent resident immigrants (USCIS Form I-551)
Seasonal agricultural workers (H-2A Visa)
Refugee, parolee, and asylee immigrants
Undocumented immigrants
Dual national U.S. citizens
Incarcerated, or hospitalized, or institutionalized for medical reasons
Able to function in public with or without assistance
Continually conned to a residence, hospital, or institution
Conned
Handicapped physically or mentally
X
X*
X
X*
X*
X
X
X*
X
X
X
X
X
X
X
X
X
X
X*
*Must register within 30 days of release unless already age 26.
NOTE: To be fully exempt you must have been on active duty or confined continuously from age 18 to 26.
**Residents of Puerto Rico, Guam, Virgin Islands, and Northern Mariana Islands are U.S. citizens. Citizens of American Samoa are nationals and
must register when they are habitual residents in the United States or reside in the U.S. for at least one year. Habitual residence is presumed
and registration is required whenever a national or a citizen of the Republic of the Marshall Islands, the Federated States of Micronesia, or Palau,
resides in the U.S. for more than one year in any status, except when the individual resides in the U.S. as an employee of the government of his
homeland; or as a student who entered the U.S. for the purpose of full-time studies, as long as such person maintains that status.
NOTE: Immigrants who did not enter the United States or maintained their lawful non-immigrant status by continually remaining on a valid visa
until after they were 26 years old, were never required to register. Also, immigrants born before 1960, who did not enter the United States or
maintained their lawful non-immigrant status by continually remaining on a valid visa until after March 29, 1975, were never required to register.
U.S. citizens or immigrants who are born male and have changed their gender to female
Individuals who are born female and have changed their gender to male
Transgender People
X
X
Selective Service - Who Must Register
INSTRUCTIONS
For filling out the "Request for Status Information Letter"
SECTION 1:
Name
: you must provide your complete name, and any other names you have ever used. If you have more than one
last name, you must provide both names.
Address: you must include your complete mailing address. Forms received without a mailing address will not be
processed.
Social Security Number: If you have a Social Security Number, you must provide it. Also, if you have ever used a
different Social Security Account Number, provide that as well.
Date of Birth: This form is only for men born after December 31, 19597 who are 26 years old or older. You must
provide your complete date of birth.
Daytime Telephone Number: If possible, provide a telephone number where you can be reached during the day, in case
we need to contact you.
E-mail Address: If possible, provide your e-mail address in case we need to contact you.
SECTION 2:
This se
ction is for explaining and documenting why you did not register with Selective Service. This section consists of
five different parts. You must complete and submit documentation for any and all parts that apply to you.
Military
: To obtain proof of military service (DD-214, Official Military Personnel File) write to: National Personnel
Records Center, GSA, Military Personnel Records Center, 9700 Page Blvd., St. Louis, MO, 63132. Or visit
http://www. archives.gov/veterans/military-service-records
Incarcerated. Institutionalized, hospitalized or confined to home: for each instance, provide type of confinement, dates
of confinement, and supporting documentation.
Non Citizen / Alien:
If you entered the United States for the first time after your 26th birthday, you must provide documentation to support
your claim. Valid documentation includes: entry stamp in your passport, I-94 with entry stamp on it. If you entered the
United States illegally after your 26th birthday, you must provide proof that you were not living in the United States
from age 18 to age 26. Please note: your Resident Alien Card (Green Card) is not valid as proof of entry to the United
States.
If you entered the United States as a valid non-immig
rant alien, and remained in that status to your 26th birthday, you
must provide documentation to support your claim. For example, if you entered the United States as an F-1 Student,
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 documents for this situation include
copies of your 1-20s or a letter from the school you attended indicating your full time attendance as a non-immigrant
alien). The same thing applies for all non-immigrant statuses. You must explain, if at any point, you violated the terms
of your visa, or overstayed your visa and became an undocumented alien.
You should provide as much information as possible. We will use the information you provide to determine your
registration status.
Transsexual: For individuals who have had a sex change. You must indicate what gender you were born as, and attach
documentation which indicates this as well.
Reason why you failed to register with Selective Service upon reaching age 18 and before reaching age 26: Provide a
written explanation for not registering with Selective Service.
(continued on next page)
SECTION 3:
Sign an
d date the letter. Return this letter to the address listed with copies of supporting documents, showing proof and
anything else you may wish to include. Do not send original documents, as they will not be returned. You should retain a
copy of all documents and correspondence submitted.
HELPFUL INFORMATION
This form is designed to be printed for use, and cannot be completed online. After printing: complete the form, attach
ALL supporting documentation, and mail to: Selective Service System, ATTN: SIL, PO Box 94638, Palatine, IL
60094-4638.
This form is for use only by men born after December 31, 1959, who are not registered and are now 26 years old or
older.
This form is not a registration form, and by submitting it, you will not be registered.
If you feel that you have already registered, verify your registration on our website (www.sss.gov), or call our
Registration Information Office at (847) 688-6888 to obtain your Selective Service number.
We will issue a Status Information Letter based on the information you provide. This letter will clarify your status with
Selective Service
If you are being denied a right, benefit, or privilege because you are not registered, submit a copy of your status
information letter and an explanation letter for your failure to register, to the Agency administering the right, benefit, or
privilege. That Agency will make the final determination regarding your eligibility- The Selective Service System does
not determine your eligibility for any right, benefit, or privilege.
Request for Status Information Letter
I am requesting a Status Information Letter. I am a male who is not registered with Selective
Service. I am now 26 years old or older,
and was born after December 31, 1959.
Section 1:
Name
List any other names used
Current Mailing Address
Social Security Number
Date of Birth ________________________________
Month / Day | Year
Daytime Telephone Number ___________________________________________________________________
E-mail Address ______________________________________________________________________________
Student Financial Aid
If this request for status information letter is related to the student financial aid process, please provide
the address of the school, college, university you plan to attend or are attending.
Name of School _______________________________________________________________________
Street Address ________________________________________________________________________
City/Town ___________________________________________________________________________
State and Zip Code ____________________________________________________________________
Phone __________________________________ Fax Number __________________________________
First
Middle Last
Include any multiple last names
Street Address
Zip Code
City
Section 2:
MILITARY:
List dates of active duty service: ___________________ to _____________________
List dates of reserve duty service: ___________________ to
_______________________
List dates of military school service: _____________________ to _____________________
Military school attended: ________________________________________________________
Attach copy of DD214 (or DD Form 4 if still on active duty)
INCARCERATED, INSTITUTIONALIZED, HOSPITALIZED, OR CONFINED TO HOME:
List dates during which you were (circle appropriate situation) incarcerated,
institutionalized, hospitalized, or confined to home. For multiple dates, list all.
__________ to __________ , __________ to __________ , __________ to __________
Attach proof of each instance
NON CITIZEN / ALIEN
Date you entered the United States for the first time: ________________________________
Month / Day / Year
USCIS (Formerly INS) status at time of entry:___________________________
List all alien status(es) held since entering the country, and give dates:
(Attach separate sheet if necessary)
_____________to_____________ USCIS Status: ________________________________
_____________to_____________ USCIS Status: ________________________________
_____________to_____________ USCIS Status: ________________________________
Attach copies of supporting documentation (see following information sheet for
detailed instructions regarding this)
TRANSSEXUAL:
At birth my gender was: _________________________
Attach copy of birth certificate
REASON WHY YOU FAILED TO REGISTER WITH SELECTIVE SERVICE UPON
REACHING AGE 18 AND BEFORE REACHING AGE 26:
_____________to_____________ USCIS Status: ________________________________
__________________________________________________________________________
Section 3:
Print, sign and date, then send this letter, together with ALL copies of required documents
and any other supporting information you may wish to include to:
Selective Service System
ATTN: SIL
PO Box 94638
Palatine, IL 60094-4638
_____________________________________________________________________________________
Signature Date
No action can be taken until we receive ALL of the information/documentation needed.
You should retain a copy of all documents and correspondence submitted to us.
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Kentucky Community & Technical College System - Request for Selective Service Reconsideration

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Completed 14 April 2020

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