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2015-2016
Selective Service Registration
Financial Aid Office
3200 West C Street
Torrington, WY 82240
p: 307.532.8224
f: 307.532.8222
[email protected]
The Selective Service reported that you have not registered with them and we need to confirm your status. Men are required to
register with the Selective Service System within 30 days of reaching their 18th birthday. You (and a parent, if dependent) must
complete and sign this worksheet and submit it with any supporting documentation to the Financial Aid Office at EWC.
STUDENT INFORMATION
______________________________________________________________
Last Name
First Name
M.I.
______________________________________________________________
Address (include apartment number)
___________________________________________
EWC Student ID Number
___________________________________________
Social Security Number (last four digits)
______________________________________________________________
City, ST, Zip
___________________________________________
Phone Number (include area code)
SELECTIVE SERVICE INFORMATION
Federal and some State laws require registration-age men applying for certain benefits (such as student financial aid,
government employment, U.S. citizenship, and job training) to be registered with Selective Service. In addition to being
subject to prosecution, failure to register may cause you to permanently forfeit eligibility for these benefits, as men cannot
register after reaching age 26.
In order to receive federal student aid, you must be registered with Selective Service if you are a male who is at least 18
years old and born after December 31, 1959. If you are a male and are 18-25 years of age, have not yet registered with
Selective Service and give Selective Service permission to register you, you must complete the Selective Service
registration form, which you can pick up at any U.S. Post Office. You may also register online via your FAFSA at
fafsa.gov or via the Selective Service website at sss.gov.
Your financial aid cannot be finalized if you are not registered with the Selective Service.
Please check the appropriate response:
□
□
□
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I was born before 1960 and not required to register for Selective Service.
My birth date is:
I am/was on active duty in the Armed Forces. My DD214 is attached.
I am a male, age 18 – 25 registered with Selective Service and a copy of my registration confirmation
is attached. (A registration form may be obtained at the local post office or register online at www.sss.gov.)
I give permission to the Financial Aid Office to make a correction to my FAFSA to register me with
Selective Service.
NOTE: If you believe you have already registered or meet other exemption criteria, contact the Selective Service at
1-847-688-6888 or toll-free 1-888-655-1825.
CERTIFICATIONS AND SIGNATURES
By signing this worksheet, I/we certify that all of the information reported is complete and correct. I/we also acknowledge that I/we
have read and agree to comply with all verification policies as stated by EWC. Failure to submit information in a timely fashion
may result in the application being filed as inactive with no further consideration and no federal aid for the academic year.
____________________________________________________
_____________________________________________________
Student’s signature
Parent’s signature (If dependent)
Date
Date
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, sentenced to jail, or both.
2/2015