"For your
convenience print, complete & return this form"
STATEMENT OF SELECTIVE SERVICE REGISTRATION COMPLIANCE
In August 1986, the Ohio Assembly passed House Bill 845 which requires that all male students between the ages of 18-26 and who are Ohio residents, must register with the Selective Service and file a statement of their selective service status, or must be charged the tuition surcharge for non-Ohio residents for attendance at any state college or university.
Kent State University and its eligible male students are required to verify selective service status; please do so by checking the appropriate statement and signing your name.
| _________________________________________________ ______________________ | |||
| (Last Name) | (First) | (M.I.) | (Social Security Number) |
| ____ | I am female. |
| ____ | I am an Ohio resident under the age of eighteen (18) years old and am therefore not currently required to register with the selective service. (I understand on my 18th birthday I must register for selective service and certify to Kent State University, University Registrar's office, the selective service number.) |
| ____ | I am an Ohio resident over the age of twenty-six (26) years old and am therefore not required to register with the selective service. Date of birth is ______________. |
| ____ | I am on active duty with the Armed Forces of the United States other than for training in a Reserve or National Guard Unit. |
| ____ | I am not a resident of Ohio and am therefore not covered by Ohio law. |
| ____ | I am non-immigrant lawfully in the United States and not required to register. |
| ____ | I am a veteran. |
| ____ | I am a male, Ohio resident between the ages of eighteen
and twenty-six and have registered with the selective service. My selective service number is _____________________. If you are registered, but have not received your or have lost your number, call 1-847-688-6888. |
| ____ | I have recently registered with selective service within the past six weeks, however, since selective service processing may take four to six weeks, I have not yet received my confirmation. I understand that should I appear listed as noncompliant (not registered) next semester, I will be assessed the non-Ohio tuition surcharge for this semester as well as all future semesters until I show proof of registration. |
Please return this completed form to: Office of the University Registrar, 122 Michael Schwartz Center, Kent State University, Kent, OH 44242. Fax #330-672-4836. Failure to return the form or to verify selective service registration for those who are required to do so will result, as the law stipulates, in the assessment of the tuition surcharge for non-Ohio residents.
I certify that the above information is correct and complete.
Signature_________________________________________ Date_________________
