Selective Service Registration Form (YouthWORKS)

Selective Service Registration Consent Form
DEPARTMENT LWD AND WORKFORCE DENTLOPMENT
Participant's Name
Age
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Street Address
Apt. #
Phone Number
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City
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Who Must Register?

All male U.S. citizens and male aliens living in the U.S., who are ages 18 through 25 are required to register for the military draft. (The last time men were drafted into the military was during the Vietnam War
What Happens if I Fail to Register

Failure to register is a violation of Federal Law. It may result in a criminal conviction, imprisonment for up to five years and/or a fine of $250,000.00. Failure to register may also cause you to be denied the following: Federal Financial and Student Loans for college, Disqualification for U.S. Citizenship and Immigration Services, Disqualification for Federal Job Training under the Workforce Innovation and Opportunity Act, Disqualification for Federal Jobs
By signing below, I First Name Last Name herby give consent to authorize Youth WORKS staff to electronically register me for the Selective Service
Participant's Signature

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YouthWORKS Staff Persons Completing Registration

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Should be Empty:

Who Must Register?