Cizenship Documentaon
The Department of Homeland Security could not confirm that you are a U.S. cizen or naonal or an eligible non‐cizen.
Federal regulaons require verificaon of your status before COCC can oer you federalnancial aid. Please review the
categories below to find the one that applies to you. Bring this form and original documents to the Financial Aid Office in
the Boyle Educaon Center. If you have quesons please call the Financial Aid Office.
Check the cizenship status that applies to you and submit one of the required documents:
U.S. Cizen or Naturalized U.S. Cizen
Birth cerficate if you were born in the U.S. ‐or‐
Cerficaon of Naturalizaon (N‐550 or N‐570) ‐or‐
Cerficate of Cizenship (N560 or N561) ‐or‐
State Department Form (FS‐240, 545, DS 1350) ‐or‐
U.S. Passport (current or expired).
Permanent Resident of the United States
Resident Alien Card (I‐551 issued before 1997) both sides required ‐or‐
Permanent Resident Card (I‐551 issued aer 1997) ‐or‐
Alien Registraon Receipt Card (I‐151 issued before June 1978) ‐or‐
Arrival/Departure Record (form I‐94) stamped “Processed for I‐551” or “Temporary Form I‐551”.
Eligible Non‐cizen
Arrival/Departure Record (form I‐94) stamped or endorsed as one of the following:
 “Admied as a Refugee Pursuant to Secon 207 of the Act. If you depart the U.S. you will need prior
permission to return. Employment Authorized” ‐or‐ “Status changed to refugee pursuant to Secon
207 (c)(2) of the Immigraon naonality Act, on . Employment Authorized.”
 “Asylum status granted pursuant to Secon 208, USCIS. Valid to . Employment
 A stamp indicang that the student has been paroled into the United States for at least one year, with
a date that has not expired.
 “Cuban‐Haian Entrant”.
 Vicms of human trafficking with I‐94 coded as T1, T2, T3, or T COA.
Violence Against Women Act (VAWA):
 Provide a I‐797 form or Cerficaon Leer indicang establishment of prima facie case.
Note: Documentaon provided as proof of your immigraon status may legally be photocopied by the Financial Aid
Office as long as the photocopy is made for this lawful purpose. Document photocopying is generally not permied for oth‐
er purposes.
Financial Aid Office
541.383.7260 • fax: 541.383.7506
2600 NW College Way, Bend, Oregon 97703‐aid • e‐mail:
By signing this form, I cerfy the informaon reported is true and accurate. Adobe or signature type fonts will not be ac‐
Student name printed COCC ID number
Student signature Date
Original received by:
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