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Boston College
Ever to Excel
Citizenship Information Form
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Citizenship Information Form
Version 2.0
Section 1
Last Name:
First Name:
Middle Initial:
Social Security Number:
EAGLE ID:
(First 8 digits on BC Eagle-One Card)
Daytime Telephone Number:
(
)
Section 2
(If Yes, proceed to Section 4)
I am a U.S. Citizen
Yes
No
Section 3 (U.S. Permanent Residents only)
I am a U.S. Permanent Resident
Yes
No
(please attach a copy of your Alien Registration Card ("green card") and fill out Section 3 below)
Country of Citizenship:
Dates on "Green Card" (use mm/dd/yyyy format):
from
to
Section 4 (optional)
Voluntary Self-Identification:
(Select one)
Asian/Pacific Islander
Black/African American
Caucasian/Non-Hispanic
Hispanic/Latino
Native American
None Selected
Section 5
I verify that the above information is correct:
Signature: ________________________________
Date: __________