THE UNIVERSITY OF AKRON
OFFICE OF THE UNIVERSITY REGISTRAR
AKRON, OH 44325-6208
The University of Akron and its male students are required to comply with the provisions of this law relating to verification; please do so by making the appropriate statement and signing your name.
Last Name: First Name: M.I. Social Security Number:
I am not required to be registered with Selective Service or provide verification because:
(Check one below)
I am female.
I am an Ohio resident under the age of eighteen (18) years and am, therefore, not currently required to register with Selective Service. I understand that on my 18 th birthday I must register for Selective Service and certify the Selective Service
Number to the University of Akron.
I am an Ohio resident over the age of twenty-six (26) years and am therefore not required to register with the Selective Service. Date of birth is
_________________________.
I am on active duty with the Armed Forces of the United States other than for training in a Reserve or National Guard unit. Indicate branch of service
______________________________________.
I am not a resident of the State of Ohio and am, therefore, not covered by the Ohio law.
I am a non-immigrant lawfully in the United States and not required to register.
I am a male, Ohio resident between the ages of eighteen (18) and twenty-six (26) and have registered with Selective Service. My Selective Service Number is
________________________________________________.
I have not registered.
I have registered but have not received my Selective Service Number.
I have registered but I have misplaced my Selective Service Number. (STUDENT: Please call the
Selective Service Office at 1-847-688-6888).
Please return this completed form to the Office of the University Registrar. Failure to return the form or to verify Selective Service Registration for those who are required to do so will result, as the law stipulated, in the assessment of the out-of-state surcharge.
I certify that the above information is correct and complete.
Signature _____________________________________________
FOR OFFICE USE ONLY
[ ] Mtc Necessary [ ] Mtc Completed
Date ____________________ rev 10/01