2012-2013
MCC ID#
SELECTIVE SERVICE REGISTRATION STATEMENT
The United States Department of Education Pell Grant Program could not confirm your
registration with Selective Services. Please check one of the following that applies to why you
did not register with the Selective Service.
I entered the United States after my 26th birthday. Attached is documentation to
verify this statement.
I did not register with the Selective Services because I was a lawful nonimmigrant and
maintained that status between my 18th and 26th birthdays, and was not required to register.
Attached is documentation to verify this statement.
I entered the United States between my 18th and 26th birthday as a legal nonresident.
I am now over 26 years of age and cannot register with the Selective Service.
Attached is documentation to verify this statement. I did not register because:
Other:
(Print) Student’s Name
Social Security Number
Student’s Signature
Date
Professional Judgment — For Financial Aid Use Only
DENIED
FA SIGNATURE:
APPROVED
DATE: