CTZ
2016-17 Citizenship Documentation
University of Wisconsin-Stout
Financial Aid Office Student Name _______________________________ Campus ID _________________ The U.S. Department of Homeland Security could not confirm that you are a U.S. citizen or non‐citizen that is eligible to receive federal financial aid. The U.S. Department of Education now requires that you present original documentation to confirm citizenship. You will be required to complete this form every year unless you update your citizenship status with the Social Security Administration! Visit www.socialsecurity.gov to find the SSA office closest to you. Be prepared to show them your U.S. Passport, Certificate of Naturalization or Certificate of Citizenship. There are TWO options to validate your citizenship:
Option 1: Present your original citizenship document in person at the UW-Stout Financial Aid Office
For Office Use Only: Type of citizenship document presented in person ________________________________________________ I verify that I saw the original document listed above in person________________________________________________________ (make a copy of the original document and image it with this form) (Financial Aid Office Staff Signature) (Date) Option 2: Notary’s certificate of acknowledgement (if you cannot appear in person)
If you, the student, cannot appear in person at the UW‐Stout Financial Aid Office, you must have this form notarized. Then, mail the following to our office (address is below): this original notarized form, a photocopy of your citizenship document, and a photocopy of the government‐issued photo ID that is acknowledged in the notary statement below (such as, but not limited to, a driver’s license, US Passport, or other state‐issued ID). The Department of Homeland Security permits photocopying of these documents for the purpose of applying for financial aid. Student Statement (sign in the presence of a notary): I certify that I am the individual signing this statement, and I am providing a copy of my citizenship documents along with a copy of a valid government‐issued photo ID card bearing my portrait (or likeness). I certify that the attached documents and government‐issued photo ID are the true, exact, and complete copies of the originals issued to me. I understand that providing false or misleading information or documents is punishable by fine or imprisonment and may make me liable for repayment of any funds received on the basis of information and documents I have provided. Student Signature _________________________________________________ Date _______________________ List the documents you are presenting: Name of Valid Photo ID Expiration Date of Valid Photo ID
Issuing Authority of Valid Photo ID
Name of Citizenship and/or Immigration Document(s)
Expiration Date (if any)
Notary Certificate of Acknowledgment: State ______________________ City/County ____________________________________ On _________________________________ , before me, ______________________________________________, (date) (notary’s name) personally appeared, ____________________________________, and provided to me on basis of satisfactory evidence of (printed name of student) identification________________________________________ to be the above‐named person who signed the foregoing instrument. (type of government‐issued photo ID provided) Witness my hand and official seal Notary Signature ______________________________________________ My commission expires on ________________________ UW‐Stout Financial Aid Office 210 Bowman Hall, 802 South Broadway Street Menomonie, WI 54751 Email: finaid1@uwstout.edu Phone: 715.232.1363 CTZ 2016