Eastern Illinois University
Selective Service Compliance Card
Print Name:__________________________________________
Social Security Number:__________________________________
Notice: You will not receive your title IV financial aid or
financial aid funded in whole or in part by this state unless you complete
this statement and, if required, give proof to your school of your registration
compliance. If you purposely state falsely that you are registered or
that you are not required to be registered, you may be subject to fine
or imprisonment, or both. (20 U.S.C. 1091 and 50 U.S.C. Appt 463). You
can register online at the Selective
Service Registration web site.
Please check ONE of the following statements that best
applies to yourself:
________ I certify that I am not required to be registered with
Selective Service, because (check only one)
_______ I am a female
_______ I am in the armed forces on active duty (Note: Members of the
Reserves and National Guard are not considered on active duty.)
_______ I have not reached my 18th birthday.
_______ I was born before 1960.
_______ I am a permanent resident of the Trust Territory of the Pacific
Islands or the Northern Marianna Islands.
_______ I am a nonresident, nonimmigrant alien.
_______ I certify that I am registered with Selective Service.
I declare under penalty of perjury that the foregoing is true
and correct.
Student Signature: _______________________________________
Date:____________________
You can also print this form in pdf format.
Please print, complete and return form to:
Eastern Illinois University
Office of Financial Aid
600 Lincoln Ave
Charleston IL 61920-3099
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