SJSU Verfication of Citizenship
Content
TYPE ON THIS FORM
2015-2016
VERIFICATION OF CITIZENSHIP
Student San Jose State I.D. Number
Student Last Name
Student First Name
The Social Security Administration (SSA) was unable to confirm your U.S. citizenship. Verify this information
by checking the appropriate box below and return this form to the Financial Aid and Scholarship Office
along with supporting documentation.
I am a continuing student and provided documentation during a prior academic year. If I do not have
proper documentation on file, I understand I must provide it when I am contacted by the Financial Aid
and Scholarship Office.
If you are a U.S. citizen, attach one of the following:
A photocopy of your birth certificate
A photocopy of your U.S. passport
A photocopy of your Certificate of Naturalization
A photocopy of Form FS-240 (Report of Birth Abroad of a Citizen of the United States)
A photocopy of Form FS-545 (Certificate of Birth – Foreign Service)
A photocopy of Form DS-1350 (Certificate of Birth)
A photocopy of INS Form G-639 (Freedom of Information Act Form)
If you are not a U.S. citizen and made an error, indicate your correct citizenship status below:
I am neither a U.S. citizen nor an eligible noncitizen.
I am an eligible noncitizen (you must bring your original eligible noncitizen documentation
to our office).
By signing this form, I certify that all of the information to qualify for student financial aid is complete and
correct. WARNING: If you purposely give false or misleading information on this form, you may be fined, sent
to prison, or both.
Student Signature
Return this form by mail or in person with supporting documentation:
By Mail:
In Person:
Financial Aid and Scholarship Office
Financial Aid and Scholarship Office
One Washington Square
Student Services Center
1st floor of the North Parking Garage
San Jose, CA 95192-0036
Date
Questions?
Phone: 408-283-7500
Email: [email protected]
USCT
2015-2016
VERIFICATION OF CITIZENSHIP
Student San Jose State I.D. Number
Student Last Name
Student First Name
The Social Security Administration (SSA) was unable to confirm your U.S. citizenship. Verify this information
by checking the appropriate box below and return this form to the Financial Aid and Scholarship Office
along with supporting documentation.
I am a continuing student and provided documentation during a prior academic year. If I do not have
proper documentation on file, I understand I must provide it when I am contacted by the Financial Aid
and Scholarship Office.
If you are a U.S. citizen, attach one of the following:
A photocopy of your birth certificate
A photocopy of your U.S. passport
A photocopy of your Certificate of Naturalization
A photocopy of Form FS-240 (Report of Birth Abroad of a Citizen of the United States)
A photocopy of Form FS-545 (Certificate of Birth – Foreign Service)
A photocopy of Form DS-1350 (Certificate of Birth)
A photocopy of INS Form G-639 (Freedom of Information Act Form)
If you are not a U.S. citizen and made an error, indicate your correct citizenship status below:
I am neither a U.S. citizen nor an eligible noncitizen.
I am an eligible noncitizen (you must bring your original eligible noncitizen documentation
to our office).
By signing this form, I certify that all of the information to qualify for student financial aid is complete and
correct. WARNING: If you purposely give false or misleading information on this form, you may be fined, sent
to prison, or both.
Student Signature
Return this form by mail or in person with supporting documentation:
By Mail:
In Person:
Financial Aid and Scholarship Office
Financial Aid and Scholarship Office
One Washington Square
Student Services Center
1st floor of the North Parking Garage
San Jose, CA 95192-0036
Date
Questions?
Phone: 408-283-7500
Email: [email protected]
USCT
