The Department of Homeland Security could not conﬁrm that you are a U.S. cizen or naonal or an eligible non‐cizen.
Federal regulaons require veriﬁcaon of your status before COCC can oﬀer you federal ﬁnancial 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 Educaon Center. If you have quesons please call the Financial Aid Oﬃce.
Check the cizenship status that applies to you and submit one of the required documents:
U.S. Cizen or Naturalized U.S. Cizen
Birth cerﬁcate if you were born in the U.S. ‐or‐
Cerﬁcaon of Naturalizaon (N‐550 or N‐570) ‐or‐
Cerﬁcate of Cizenship (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 aer 1997) ‐or‐
Alien Registraon 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”.
Arrival/Departure Record (form I‐94) stamped or endorsed as one of the following:
“Admied as a Refugee Pursuant to Secon 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 Secon
207 (c)(2) of the Immigraon naonality Act, on . Employment Authorized.”
“Asylum status granted pursuant to Secon 208, USCIS. Valid to . Employment
A stamp indicang that the student has been paroled into the United States for at least one year, with
a date that has not expired.
Vicms 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 Cerﬁcaon Leer indicang establishment of prima facie case.
Note: Documentaon provided as proof of your immigraon 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 permied for oth‐
Financial Aid Oﬃce
541.383.7260 • fax: 541.383.7506
2600 NW College Way, Bend, Oregon 97703
www.cocc.edu/ﬁnancial‐aid • e‐mail: coccﬁnaid@cocc.edu
By signing this form, I cerfy the informaon 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: