UNIVERSITY OF HOUSTON
Selective Service System Verification 
(to be completed by all males ages 18 through 25)

Effective 9/1/99, all persons hired by a Texas state agency who are required by Federal law to be registered with the Selective Service System must present proof of registration or proof of exemption. This applies to all individuals hired by the University of Houston.

Please complete the following: (see below for registration information)

	Name (last, first): ___________________________________________________

	Social Security Number: ____________________________________________

	Date of Birth: _____________________________________________________ 

	Selective Service Registration #: ______________________________________

I am Exempt from registering because (check the one that applies):
			
  F visa		  J visa		  H1-B visa

Registration Information
Who Must Register?
•	Male U.S. citizens age 18 through 25	  
•	Male aliens living in the U.S. age 18 through 25		
Who is Not Required to Register?
•	Individuals in the U.S. on a Visa
•	Active duty military
How to Register?
•	The fastest way is on-line at www.sss.gov (Takes 2 weeks to receive card).
•	Registration forms are available at any U.S. Post Office to be filled out and mailed in to the Selective Service System (Takes 30 to 90 days to receive card).	
Please see the Selective Service System web site at www.sss.gov for more details.

(For Department Use.  Please Print.)

DEPARTMENT NAME: ___________________________________________________

CONTACT PERSON/PHONE #: ____________________________________________

SIGNATURE OF PERSON VERIFYING #: ___________________________________
(Copy of Selective Service card or verification printout must be attached.)