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Citizenship Information Form Version 1.0 Section 1 Last Name: First Name: Middle Initial: Social Security Number: EAGLE ID: Daytime Telephone Number: ( ) (First 8 digits on BC EagleOne Card) Section 2 I am a U.S. Citizen Yes No 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) Section 3 (U.S. Permanent Residents only) Country of Citizenship: Dates on "Green Card" (use mm/dd/yyyy format):from to.

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