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 master’s 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
