Please return completed paperwork to:
University Enrollment Center
285 Old Westport Road
North Dartmouth MA 02747-2300
Citizen/Eligible Non-Citizen Affidavit Form
This form is for the collection of U.S. Department of Homeland Security (DHS) or other U.S. citizenship/ eligible noncitizenship/nationality documents from students who are unable to present their documents in person.
Student Last Name
Date of Birth
I certify that I, __________________________ (print student name), am the individual signing this 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 document(s):
NAME OF VALID PH