Chicago
Illinois 60625-4699
773
/ 583-4050
Graduate
College
State
law mandates that all students participating in state supported financial
assistance programs must certify once each fiscal year their status with
regard to Selective Service registration.
Students
who fail to certify their status will have their eligibility to participate
in these programs denied.
SELECTIVE
SERVICE REGISTRATION
A.____
I certify that I am not required to be registered with Selective Service
because (check the reason below):
_____I
am a non-resident, non-immigrant alien.
_____I
am a female.
_____I
am in the armed service 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
Mariana Islands.
B.
_____ I certify I am registered with the Selective Service.*
SIGNATURE____________________________________
DATE ___________________
PRINTED
NAME __________________________________________________________
SOCIAL
SECURITY NUMBER ______________________________________________
*Please
be aware that if you are registered with the Selective Service (you checked
B) you may be required to provide a copy of your Selective Service Registration
Acknowledgement Letter at a later date.You
may request a copy from:
REGISTRATION
INFORMATION BUREAU
SELECTIVE
SERVICE SYSTEM NATIONAL HEADQUARTERS
WASHINGTON,
D.C. 20435
This
form must be completed and submitted each time you apply for a Graduate
Waiver.Present it, along with the
departmental application blank, directly to the department in which
you are doing or planning to do your graduate work.