13CITIZEN
0102 Lee Building
College Park, Maryland 20742-5145
TEL: 301-314-9000 & 888-313-2404
TTY: 301-314-7017 (for the hearing impaired)
FAX: 301-405-9265 & 301-314-9587
www.financialaid.umd.edu
OFFICE OF STUDENT FINANCIAL AID
2013-2014 Citizenship Certification
Student Name: UID:
The U.S. Department of Education performed a database match with the Social Security Administration and the U.S. Department of Homeland Security (DHS) and could not confirm your eligibility for Federal Financial Aid as a citizen or an eligible non-citizen. Please submit a copy of one of the following types of documents listed below.
A. U.S. Birth Certificate
B. U.S. Passport (current or expired)
C. Certificate of Birth Abroad of a U.S. citizen
D. Naturalization Certificate
E. Alien Registration Receipt Card (I-551 or I-151) (Please copy both sides)
F. A passport stamped and processed (Form I-551)
G. Departure Record (Form I-94) stamped and processed Form I-551
H. Form I-94 stamped:
1. Refugee
2. Cuban Haitian Entrant
3. Indefinite Parole and/or Humanitarian
4. Admitted as a Refugee pursuant to section 207
5. Conditional Entrant (I-551C)
6. Asylum
7. Status changed to Refugee
The following are NOT acceptable forms of documentation for eligibility for Federal Financial Aid:
- Employment authorization card (I-6889 or I-688B)
- A notice of approval for permanent residence (I-171 or I-464)
- If you are in the United States on an F1, F2 or M-1 exchange visa, a J1 or J2 exchange visa, a G series visa, or student visa B-1 or 2, or H or L series visa
By signing this form, I certify all information reported on this form and within the enclosed documentation is complete and correct. I understand that providing false or misleading information may result in a $20,000 fine, a prison sentence, or both, according to the Higher Education Act of 1965, as amended, Section 490(a). Any false or misleading information is subject to cancellation of all financial assistance.
Student’s Signature: Date: