Fillable Request for Status Information Letter (Walla Walla Community College)

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Request for Status Information Letter (Walla Walla Community College)

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Request for Status Information Letter
VERIFY: I am not registered with the Selective Service System and requesting a Status Information Letter.
I am now 26 years old or older and was born after December 31, 1959.
NOTE: No action will be taken on this request unless ALL REQUIRED information / documentation with an
asterisk (*) are received (where applicable). KEEP a copy of all documents and correspondence submitted.
__________________________________________________________________________
Section 1:
* Name ______________________________________________________________________________
* First Name * Middle Name * Last Name
List any other names used ________________________________________________________
Include any multiple last names
* Current Mailing Address _______________________________________________________________
* Street Address
___________________________________________________________
* City * State * Zip Code
* Social Security Number ____________________________
* Date of Birth _____________________________________
* Month / * Day / * Year
Daytime Telephone Number _____________________________________________________________
E-mail Address ________________________________________________________________________
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 DD 214 (or DD Form 4 if still on active duty)
INCARCERATED INSTITUTIONALIZED HOSPITALIZED HOME CONFINED :
* List dates during which you were incarcerated, institutionalized, hospitalized, or confined to a home.
For multiple dates, list all:
___________ to ___________ , ___________ to ___________ , ___________ to ___________
* Attach proof of each instance. Page 1 of 4
NON-CITIZEN / UNDOCUMENTED IMMIGRANT:
* Date you entered the United States for the first time: _______________________________________
* Month / * Day / * Year
* USCIS (formerly INS) status at time of entry: _____________________________________________
* REQUIRED: List all immigrant status(es) held since entering the country, and give dates:
(Attach separate sheet if necessary)
________________ to ________________ USCIS Status ________________________________
________________ to ________________ USCIS Status ________________________________
________________ to ________________ USCIS Status ________________________________
________________ to ________________ USCIS Status ________________________________
* Attach copies of supporting documentation (see the included INSTRUCTIONS for details)
TRANSGENDER:
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:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Section 3:
IMPORTANT NOTE: No action can be taken until we receive ALL required information / documentation with
an asterisk (
*) are received. You should retain a copy of all documents and correspondence submitted to us.
Print, sign and date, and mail this letter to the address below, together with ALL copies of required documents
and all other supporting information you may wish to include.
_______________________________________ _______________________________
* Signature * Date
Selective Service System
ATTN: SIL
PO Box 94638
Palatine, IL 60094-4638
Page 2 of 4
INSTRUCTIONS
For filling out the “Request for Status Information Letter”
SECTION 1:
• Name (required): 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 (required): you must include your complete mailing address. Forms received without a
mailing address will not be processed.
• Social Security Number (required, if you have one): If you have a social security number, you
must provide it. Also, if you have ever used a different social security number, provide it as well.
• Date of Birth (required): This form is only for men born after December 31, 1959, 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.
• Email Address: If possible, provide your email address in case we need to contact you.
SECTION 2: (Requires dates and supporting documentation)
This section 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 home confined:
For each instance, provide type of confinement, dates of confinement, and supporting documentation.
Non-Citizen / Undocumented Immigrants:
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 proof of entry to the United States.
If you entered the United States as a valid non-immigrant, 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 I-20s or a letter from the school
you attended indicating your full time attendance as a non-immigrant). 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 immigrant.
You should provide as much information as possible. We will use the information you provide to
determine your registration status.
Page 3 of 4
Transgender:
For individuals who have had a gender 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.
SECTION 3:
Sign and date the letter (required). Return this letter to the address listed with copies of supporting
documents, showing proof and anything else you may wish to include. IMPORTANT: 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 submitted 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
registration number.
• We will issue a Status Information Letter based on the information you provide. This letter will clarify
your status with Selective Service. KEEP your status information letter from Selective Service
in your permanent files for future reference.
• If you are being denied a right, benefit, or privilege because you are not registered, submit a copy
of your status information letter from Selective Service and a separate letter in which you explain in
the best of your ability the reasons surrounding 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.
Remember to KEEP your original Status Information Letter in your permanent files.
July 20, 2015 Page 4 of 4
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Request for Status Information Letter (Walla Walla Community College)

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Completed 4 February 2021

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