University Ave Documents
Resume:
Bronx Community College
**** ********** ***, ******* ****, Room 504
Bronx, NY 10453
************@***.****.***
Affidavit
Emely Caba Rodriguez (Emely Caba)
24064115
*********@*****.***
Certification of True, Exact, and Complete Copy of the Original Documents Caba Rodriguez Emely 24064115
Student's Last Name Student's First Name Student's ID Number 347-***-**** 9/11/2001
Student's Phone Number Student's Date of Birth
This form is for the collection of Department of Homeland Security or other U.S. citizenship/nationality documents from students unable to present their documents in person.
I certify that I, Emely Caba Rodriguez am the individual signing this statement, Printed Student's Full Name
and I am providing a copy of my documents along with a copy of a valid government-issued photo identification card bearing my likeness (picture). 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):
Type of Valid Photo ID Expiration Date of Valid Photo ID (If Any) Issuing Authority of Valid Photo ID U.S. Passport 10/20/2028 https://share.icloud.com/photos/068xmcaZma1oo_G3FFikYzYww Name of Citizenship and/or Immigration Document(s) Expiration Date of Citizenship and/or Immigration Document(s) (If Any) Resident Alien Card 7/13/2027
Each person signing this worksheet certifies that all of the information reported on it is complete and correct. WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both. The student must sign and date this form.
Student's Signature Date
Spouse's Signature (optional) Date
Certification and Signatures
Contact this candidate