Fillable (Print full name) statement, and I am providing (Brandman University)

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(Print full name) statement, and I am providing (Brandman University)

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CITIZENSHIP AND IMMIGRATION
STATUS AFFIDAVIT
Version 2.0 Revised 4-6-2020
This form is for the collection of DHS or other U.S. citizenship/nationality documents from students unable to present their documents in person
at a Brandman University campus. Send this form and the below referenced copied documents to the Brandman Financial Aid Office. You can
upload all pages via the Student Portal at Brandman.edu.
I certify that I, ________________________________________________________________, am the individual signing this
(Print full name)
statement, and I am providing (1) a copy of my documents along with (2) a copy of a valid government-issued photo identification
card such as a driver’s license or State ID.
NOTE: It is unlawful to photocopy Military ID, therefore it may not be used for this purpose.
NAME OF VALID PHOTO ID
(Driver’s license or State ID)
EXPIRATION DATE OF VALID PHOTO ID
ISSUING AUTHORITY OF VALID PHOTO ID
(state or federal)
NAME OF CITIZENSHIP AND/OR IMMIGRATION
DOCUMENT(S)
EXPIRATION DATE (IF ANY) OF CITIZENSHIP AND/OR
IMMIGRATION DOCUMENT(S)
I certify that the attached documents and government issued photo identification are the true, exact, and complete copies of the originals issued to
me. I understand that providing false or misleading information or documents is punishable by fine or imprisonment and may make me liable for
repayment of any funds received on the basis of the information and documents I have provided.
________________________________ __________________________________ __________________
Student’s Signature Student’s ID Number Date
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(Print full name) statement, and I am providing (Brandman University)

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Completed 21 July 2020

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