STUDENT FINANCIAL SERVICES
2020-2021 CLARIFICATION STATEMENT
SECTION(S) TO COMPLETE:
Section A
Section B
Section C
Section D
Last Name First Name Middle
MTC ID Phone Number
SECTION A BACHELOR’S DEGREE/GRADUATE PROGRAM
I do have a BA/BS degree or equivalent.
I do not have a BA/BS degree or equivalent.
I am enrolled in a master’s or doctorate program for 2020-2021.
I am not enrolled in a masters or doctorate program for 2020-2021.
SECTION B SELECTIVE SERVICE
I certify that I am registered with Selective Service. Please attach a copy of your web registration
record. Selective Service www.sss.gov.
I certify that I am not required to register with Selective Service because:
I am female
I was born before 1960
I have not reached my 18th birthday
I am in the armed services on active duty (Note: This does not apply to members of the
Reserves and National Guard who are not on active duty)
I entered the country after age 26 (Bring your passport and entry documents to our office)
I did not register. Send a Request for Status Information Letter to Selective Service (SS). Obtain the
request form from the Student Financial Services office or our website. Once you receive a
response from SS, submit this form, a letter explaining why you did not register, and the SS response.
SECTION C 2020-2021 MARITAL STATUS
Dependent Student-Parent(s)
Parent Marital Status
Single, Divorced, Widowed
Married/Remarried
Separated
Parents are not married, but are living together
Independent Student-Student (spouse)
Student Marital Status
Single, Divorced, Widowed
Married/Remarried
Separated
Month and year you were married, separated, divorced, or widowed:
Month Year
MIDLANDSTECH.EDU | PO BOX 2408 | COLUMBIA SC 29202 | 803.738.7792
SECTION D HOUSEHOLD SIZE
Independent Student
Dependent Student
You listed people in your household size that are not members of your immediate family. Please
explain why they are being included in the household size. Each person listed must receive more than half of their
support from you or your parents.
Full Name Age Explanation
I declare, under penalty of perjury, that the information on this form is true, complete, and accurate to the best of
my knowledge. I understand that the information on this form will be used to verify the financial aid information
provided and may require further follow up from the Office of Student Financial Services.
Signature of Student Date
Parent Signature (Dependent Students Only) Date
MIDLANDSTECH.EDU | PO BOX 2408 | COLUMBIA SC 29202 | 803.738.7792
SD-20-6284A-02-20
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