Academic Year
FINANCIAL AID AND SCHOLARSHIP SERVICES
Citizenship Verification
2016-2017
Purpose: To verify the accuracy of citizenship information reported on the Free Application for Federal Student Aid (FAFSA).
If you need assistance with completing this form, please contact our office at 855-278-5080 or students.asu.edu/contact/financialaid.
STUDENT INFORMATION
Last Name
First Name
Local Street Address
City
State
Middle I.
10-Digit ASU ID
Zip Code
Daytime Phone Number
INSTRUCTIONS
1.
2.
3.
4.
5.
This form will not be processed if any items are left blank or illegible, resulting in the delay of your financial aid disbursement.
Complete this form and attach at least one of the specified documentation listed below to this form.
Use blue or black ink only. Please type or print clearly.
If clarification of your situation is necessary, additional information or documentation may be required.
Submit this form by fax to 480-965-9484, mail to P.O. Box 870412, Tempe, AZ 85287-0412 or in person to any of the Financial Aid and Scholarship Services
office locations.
Submission Requirements


If submitting this form in person with original documentation and government issued photo ID, a notary public signature is not required on page 2.
If submitting this form with a copies of documentation and government issued photo ID, you must complete page 2 in the presence of a notary public
SECTION A: ACCEPTABLE DOCUMENTATION
Please check one of the types of documentation below and attach it to this form.
Documentation Type
 A copy of your (the student's) birth certificate showing that you were born in the United States which includes Puerto Rico, Guam, the U.S. Virgin Islands,
American Samoa, Swain's Island or the Northern Mariana Islands

A signed copy of a Certificate of Naturalization issued by USCIS (N-550 or N-570), which contains at least the following information:
1. Student's name
2. Certificate number (found in the upper right hand corner)
3. Alien Registration Number (A-number)
4. Name of the court where the naturalization occurred (prior to 1991)
5. Date of naturalization

A signed copy of a Certificate of Citizenship issued by USCIS (N-560 or N-561), which contains at least the following information:
1. Student's name
2. Certificate number (found in the upper right hand corner)
3. Date of issuance of the certificate

A signed copy of a United States passport (in the case of nationals who are not citizens, it will be stamped "Non-citizen National")

A copy of Form DS-1350 ("Certificate of Birth")

A copy of Form FS-545 ("Certificate of Birth-Foreign Service")

A copy of Form FS-240 ("Report of Birth Abroad of a Citizen of the United States")
Please note: the following are not acceptable as proof of citizenship status:

Social Security card

Driver’s license
Rev: 2016-06-09
2017
CITIZENSHIP
Page 1 of 2
Last Name
First Name
Middle I.
10-Digit Campus ID
SECTION B: CERTIFICATION OF TRUE, EXACT, AND COMPLETE COPY OF THE ORIGINAL DOCUMENTS
This form is for the collection of DHS or other U.S. citizenship/nationality documents from students unable to present their documents in person.
I certify that I, ___________________________________, am the individual signing this statement, and I am providing a copy of my documents along with a copy of a valid
government-issued photo identification card bearing my portrait (or likeness).
I certify that the attached documents and government issued photo identification are the true, exact, and complete copies of the originals issued to me.
List of document(s):
Type of Valid Government-Issued Photo ID
Expiration Date of Photo Id
Type of Citizenship Document
Issuing Authority of Photo Id
Expiration Date (if any) of Citizenship Document
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 the information and documents I have provided.
Student’s Signature
Date form was signed
Notary Public Stamp Required
______________________________________________
Notary Public
For Internal Use Only
Method of Submission
 In person with original documents and photo
ID, which I made a copy

In person with copies of documents
Type of Valid Government-Issued Photo ID
Expiration Date of Photo Id
Type of Citizenship Document
Expiration Date (if any) of Citizenship Document
Employee Name (Printed)
Employee Signature
Rev: 2016-06-09
2017
CITIZENSHIP

By mail
Issuing Authority of Photo Id
Date
Page 2 of 2