Fillable CitizenshipAffirmationofTrue,ExactandCompletecopyoftheOriginalDocumen ts NameonValidPhotoID ExpirationDate IssuingAuthority (GateWay Community College)

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CitizenshipAffirmationofTrue,ExactandCompletecopyoftheOriginalDocumen ts NameonValidPhotoID ExpirationDate IssuingAuthority (GateWay Community College)

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CitizenshipAffirmationofTrue,ExactandCompletecopyoftheOriginalDocumen ts
Purpose:ThisformisforthesubmissionofDHSorotherU.S.Citizenship/Nationalitydocumentsfromstudentswho
areunabletopresentoriginaldocumentsinpersontothecollegefinancialaiddepartment.
Pleaseallow3‐5business
daysforprocessing,orlongerduringpeakprocessingperiods
StudentName: (Printed) Date:
StudentID#
CollegeName
Iunderstandthatprovidingfalsifiedormisleadinginformationordocumentsispunishablebyfineorimprisonmentand
maymakemeliableforrepaymentofanyandallfundsreceivedonthebasisoftheinformationanddocumentsIhave
provided.
Student’sSignature Date
NotaryName(Printed) Date
NotarySealNumber
*Musthavenotarysealstampwithnotarycommissionexpirationdateandsignature*
Non‐DiscriminationStatement
TheMaricopaCountyCommunityCollegeDistrict(MCCCD)isanEEO/AAinstitutionandanequalopportunityemployerof
protectedveteransandindividualswithdisabilities.Allqualifiedapplicantswillreceiveconsiderationforemploymentwithout
regardtorace,color,religion,sex,sexualorientation,genderidentity,age,ornationalorigin.AlackofEnglishlanguageskills
willnotbeabarriertoadmissionandparticipationinthecareerandtechnicaleducationprogramsoftheDistrict.
TheMaricopaCountyCommunityCollegeDistrictdoesnotdiscriminateonthebasisofrace,color,nationalorigin,sex,
disabilityorageinitsprogramsoractivities.ForTitleIX/504concerns,callthefollowingnumbertoreachtheappointed
coordinator:(480)731‐8499.Foradditionalinformation,aswellasalistingofallcoordinatorswithintheMaricopaCollege
system,visithttp://www.maricopa.edu/non‐discrimination.
NameonValidPhotoID ExpirationDate IssuingAuthority
NameofEachOriginalDocumentsBeingSubmitted ExpirationDate(IfAny)
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CitizenshipAffirmationofTrue,ExactandCompletecopyoftheOriginalDocumen ts NameonValidPhotoID ExpirationDate IssuingAuthority (GateWay Community College)

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Completed 2 September 2020

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