Yuba Community College District
Financial Aid Office
Yuba College
2088 North Beale Road
Marysville, CA. 95901
530-749-7999
Woodland Community College
2300 East Gibson Road
Woodland, CA 95776
530-661-5725
Lake County Campus
15880 Dam Road Extension
Clearlake, CA 95422
707-995-7923
2020-2021
Identity/Citizenship Status Form
The
U.S. Department of Education requires name, social security number and date of birth be reported on the
student’s FAFSA and conducts a “match” with other Federal agencies/programs (Social Security Administration,
Department of Homeland Security, etc.) One or more matching attempts have been reported as unsuccessful. This
occurred because the information reported on the FAFSA did not match their records for:
Student Parent 1 Parent 2
Please complete this form and provide the documentation checked below. If providing parent information, parent
must also sign this form.
Social Security Card (signed)
Dr
iver’s License or State ID
Proof of Citizenship (Birth Certificate, U.S. Passport, Certificate of Citizenship, Certificate of
Naturalization)
Proof of Eligible Non-Citizen Status (Permanent Residency Card or Resident Alien Card I-551,
Arrival/Departure Record I-94)
______________________________________________________ _________________________________
Student Name (Print) Student ID #
Correct
Information
Name DOB SSN
Student
Parent 1
Parent 2
I certify that the information provided on this form and any attachments is true and correct to the best of my knowledge. I understand
that this information will be used to determine my eligibility and that false or misleading information may be cause for denial, termination,
and/or repayment of financial aid funds.
____
_____________________________
Date
____
_____________________________
Date
______________________________________________________
Student Signature
______________________________________________________
Parent Signature
_
_________________________________________________________________
Updated FMSI/FA Technician Signature
_
________________________________________
Date
REV: 3/23/20
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