| Part A |
| 1. |
During the 12 months
prior to the term for which you are applying, did you attend a public
college or university in Texas in a fall or spring term?
Yes
No |
| |
If you answered "no",
continue to Part B. If you answered "yes", complete questions 2-5. |
| 2. |
What Texas public institution did you last attend?
(Give full name, not just initials.)
|
| 3. |
In which term were you last enrolled? Last
Semester
Year
|
| 4. |
During your last semester at a Texas public
institution, did you pay resident (in-state) or nonresident (out of
state)?
Resident
Non Resident (out of state)
Unknown |
| 5. |
If you paid in-state tuition at your last institution, was it
because you were classified as a resident or because you were a
nonresident who received a waiver?
Resident
Non Resident with a waiver
Unknown |
| |
IMPORTANT: If you were enrolled at a Texas public institution during a fall or spring
semester within the previous 12 months and were classified as a Texas resident,
skip to Part I. If
you were not enrolled, or if you were enrolled but classified as a nonresident,
proceed to Part B. |
| Part B: Residency Claim |
| 1. |
Are you a resident of Texas?
Yes
No |
| |
If you answered "yes" continue to Part C.
If you answered "no", complete the following question and continue to Part I. |
| 2. |
Of what state or country are you a resident? State
Country
|
| |
If you are uncertain, continue to Part C. |
| Part C: Acquisition of High School Diploma or GED |
| 1. |
(a) Did you graduate
from high school or complete a GED in Texas? |
Yes
No |
| |
(b) If you graduated
from high school, what was the name and city of the school?
School
City
|
| 2. |
Did you live in Texas
the 36 months leading up to high school graduation or completion of the GED?
Yes
No |
| 3. |
When you begin the
semester for which you are applying, will you have lived in Texas for
the previous 12 months?
Yes
No |
| 4. |
Are you a U. S.
Citizen or Permanent Resident?
Yes
No |
|
If you answered "no" to question 1(a) or 2 or 3, continue to Part D.
If you answered "yes" to
all four questions, skip to Part I.
If you answered "yes" to
questions 1, 2 and 3, but "no" to question 4, complete a copy of the
Affidavit in Chart III, provided as an attachment to this
form, skip to Part I of this form and submit both this form and the
affidavit to your institution. |
| Part D: Basis of Claim to Residency. |
| |
(To Be Completed By Everyone Who Did Not Answer "Yes" to Questions 1(a),
2 and 3 of Part C.) |
| 1. |
Do you file your own federal income tax as an independent tax payer?
Yes
No |
| 2. |
Are you claimed as a dependent or are you eligible to be claimed as
a dependent by a parent or court-appointed legal guardian?
Yes
No |
| |
(To be eligible to be claimed as a dependent,
your parent or legal guardian must provide at least one half of your
support. A step-parent does not qualify as a parent if he or she has
not adopted the student.) |
| 3. |
f you answered "No" to both questions above, who provides the
majority of your support?
Self
Parent or legal guardian
Other If "other", list here
|
| |
If you answered "yes" to question 1, continue to Part E.
If you answered "yes" to question 2, skip to Part F.
If you answered "no" to 1 and 2 and "self" to question 3, continue to Part E.
If you answered "no" to 1 and 2 and "parent or legal guardian" to
question 3, skip to Part F.
If you answered "no" to 1 and 2 and "other" to question 3, skip to Part G and provide an explanation, and complete the Part I section of this
form. |
| Part E |
| |
Questions for students who answered "Yes" to question 1 or "Self" to
question 3 of Part D. |
| 1. |
Are you a U. S. Citizen?
Yes
No |
| 2. |
Are you a Permanent Resident of the United States of America? (A
COPY OF THE FRONT AND BACK OF YOUR PERMANENT RESIDENT ALIEN CARD MUST BE
SENT TO THE OFFICE OF ADMISSIONS)
Yes
No |
| 3. |
Are you a foreign national whose application for Permanent Resident
Status has been preliminarily reviewed? (You
should have received a fee/filling receipt or Notice of Action (I-797)
from USCIS showing your I-485 has been reviewed and has not
been rejected.)
Yes
No |
| 4. |
Are you a foreign national here with a visa or are you a Refugee, Asylee, Parolee or here under Temporary
Protective Status? (A
COPY OF YOUR VISA MUST BE SENT TO THE OFFICE OF ADMISSIONS) |
Visa
Refugee
Asylee
Parolee
Temporary Protective Status |
| 5. |
Do you currently live in Texas?
Yes
No |
| |
If you are out of state due to a temporary assignment
by your employer or other temporary purpose, please explain in question
7. |
| 6. |
(a) If you currently live in Texas, how long have you been living here? |
Months
|
Years
|
| |
(b) What is your main purpose for being in the
state?
Go to College
Establish/Maintain a Home
Work Assignment |
| |
If for reasons other than those listed above, give an
explanation in Part G. |
| 7. |
(a) If you are a member of the U. S. military, is Texas you Home of
Record?
Yes
No |
| |
(b) What state is listed as your military legal residence for tax
purposes on your Leave and Earnings Statement?
|
| 8. |
Do any of the following apply to you ? (check all that apply) |
| |
(a) Hold the title to real property (home, land) in Texas?
If yes, date acquired:
Yes
No |
| |
(b) Own a business in Texas?
If yes, date acquired:
Yes
No |
| |
(c) Hold a state or local license to conduct a business or practice a
profession in Texas?
If yes, date acquired:
Yes
No |
| 9. |
For the past 12 months have you: (check all that apply) |
|
| |
(a) Been gainfully employed in Texas?
Yes
No |
| |
(b) Received services from a social service agency that provides
services to homeless persons?
Yes
No |
| 10. |
(a) Are you married to a person who could answer "yes" to any part of
question 8 or 9?
Yes
No |
|
(b) If "yes," indicate which question could be answered "yes" by your
spouse:
8a
8b
8c
9a
9b |
| |
(c) How long have you been married to the Texas resident? |
Months
|
Years
|
| |
Skip Part F and continue to Part G. |
|
| Part F |
| |
Questions for students who answered "Parent" or "Legal Guardian" to
question 3 of Part D. |
| 1. |
Is the parent or legal guardian upon whom you base your claim of
residency a U. S. Citizen?
Yes
No |
| 2. |
Is the parent or legal guardian upon whom you base your claim of
residency a Permanent Resident?
Yes
No |
| 3. |
Is this parent or legal guardian a foreign national whose application
for Permanent Resident Status has been preliminarily reviewed? (He or she should have received a fee/filling receipt or Notice of
Action (I-797) from USCIS showing his or her I-485 has been reviewed and
has not been rejected.)
Yes
No |
| 4. |
Is this parent or legal guardian a foreign national here with a visa or
a Refugee, Asylee, Parolee or here
under Temporary Protective Status? |
Visa
Refugee
Asylee
Parolee
Temporary Protective Status |
| 5. |
Does this parent or legal guardian currently live in Texas?
Yes
No |
| |
If he or she is out of state due to a temporary
assignment by his or her employer or other temporary purpose, please
explain in Part G. |
| 6. |
(a) If he or she is currently living in Texas, how long has he or she
been living here? |
Months
|
Years
|
| |
b) What is your parent's or legal guardian's main purpose for being in
the state?
Go to College
Establish/Maintain a Home
Work Assignment |
| |
If for reasons other than those listed, give an explanation in Part G. |
| 7. |
(a) If he or she is a member of the U. S. Military, is Texas his or her
Home of Record?
Yes
No |
| |
b) What state is listed as his or her military legal residence for tax
purposes on his or her Leave and Earnings Statement? |
|
| 8. |
Do any of the following apply to your parent or legal guardian? (check all that apply) |
| |
(a) Hold the title to real property (home, land) in Texas?
If yes, date acquired:
Yes
No |
| |
(b) Own a business in Texas?
If yes, date acquired:
Yes
No |
| |
(c) Hold a state or local license to conduct a business or practice a
profession in Texas?
If yes, date acquired:
Yes
No |
| 9. |
For the past 12 months, has your parent or legal
guardian: (check all that apply) |
| |
(a) Been gainfully employed in Texas?
Yes
No |
| |
(b) Received services from a social service agency that provides
services to homeless persons?
Yes
No |
| 10. |
(a) Is your parent or legal guardian married to a person who could
answer "yes" to any part of question 8 or 9?
Yes
No |
| |
(b) If "yes," indicate which question could be answered "yes" your
parent or guardian's spouse:
8a
8b
8c
9a
9b |
| |
(c) How long has your parent or guardian been married to the Texas
resident? |
Months
|
Years
|
| Part G: General Comments |
| |
Is there any
additional information that you believe your college should know in
evaluating your eligibility to be classified as a resident? If so,
please provide it below: |
| |
|
| Part I: Certification of Residency |
| |
All students must complete this section. |
| |
I understand that officials of my college/university
will use the information submitted on this form to determine my status
for residency eligibility. I authorize the college/university to verify
the information I have provided. I agree to notify the proper officials
of the institution of any changes in the information provided. I certify
that the information on this application is complete and correct and I
understand that the submission of false information is grounds for
rejection of my application, withdrawal of any offer of acceptance,
cancellation of enrollment and/or appropriate disciplinary action. |
| |
Entry of your initials and email substitutes for an electronic signature. |
Initials:
. Email:
|