AFFIDAVIT OF ELIGIBLE NONCITIZENSHIP, U.S. CITIZENSHIP OR U.S.

NATIONAL STATUS

The U.S. Department of Homeland Security-U.S. Citizenship and Immigration Services (DHS-USCIS) data match must confirm a student’s eligibility for Title IV, HEA student financial assistance. The U.S. Department of Education has been given approval by DHS-USCIS for students to photocopy original immigration documents for establishing Title IV aid eligibility. This form is for the collection of DHS-USCIS or other U.S. citizenship/nationality documents from students unable to present their documents to the school in person. The student applicant must complete the certification below in the presence of a notary public. CERTIFICATION OF TRUE, EXACT, AND COMPLETE COPY OF THE ORIGINAL DOCUMENT(S) I certify that I, , am the individual signing this (Print student’s full name) 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 documents: Name of Valid Photo ID Expiration Date of Valid Photo ID Issuing Authority of Valid Photo ID Name of Citizenship and/or Expiration Date (if any) of Citizenship and/or Immigration Document (s) Immigration Document (s) SUBSCRIBED TO AND SWORN TO BEFORE ME, on the ______________________________day of

_________________________________, 20________, to certify which witness my hand and official seal.

_________________________________________ Notary Public signature

Concordia University Texas · Student Financial Services · 11400 Concordia University Dr. · Austin, TX 78726