a p p l i c a t i o n f o r r e - a d m i s s i o n
B. Statistical Info:
The following information is used in Federal and State reports which collect data on equal opportunity for education and employment. Your response does not
affect your admission to Darton State College.
Ethnic Status (optional): Are you Hispanic or Latino? Yes No Sex (optional): Male Female
Race: White Native Hawaiian or other Pacic Islander Asian Black or African American American Indian or Alaskan Native
C. Resident/Tuition Status:
Citizenship Status: US Citizen by Birth US Citizen by Naturalization Resident Alien (please attach a copy of both sides of
Non-Resident Alien Visa Type ________________________
Country of Citizenship (if not US citizen) ______________________________________________________________________________
Tuition Classication Information: University System of Georgia students are responsible for registering under the proper tuition
classication. In general, classication of in-state status for tuition purposes requires an individual to have established domicile in Georgia
for a minimum of 12 consecutive months immediately preceding the rst day of classes for the term in which the student plans to enroll.
Domicile is dened as a person’s present, permanent home where the individual intends to stay indenitely and to which the individual
returns following periods of temporary absence. Temporary residence does not constitute the establishment of one’s domicile.
Residency is dened as the state and country where an individual currently lives. An individual may reside in Georgia without having
established domicile in the state. See above denition of domicile.
Are you applying for in-state tuition? Yes No
If you answered “Yes” to the above question, all of the following must be answered.
Yes No Have you established and maintained domicile in Georgia (according to the denition above) for at least 12 consecutive
months immediately preceding the rst day of classes for the term in which you plan to enroll?
Yes No If you are under the age of 24, has a parent(s) or US court-appointed legal guardian established and maintained domicile
(according to the denition above) in Georgia for at least 12 months immediately preceding the rst day of classes for the
term in which you plan to enroll?
Yes No Have you ever lived outside the state of Georgia?
If yes, how long have you continuously resided in the state of Georgia? Years______Months______Date:______-______
From To
If you ever lived outside the state of Georgia, what was your primary reason for moving to the state (check all that apply):
Part-time work Full-time work Employment of Spouse Employment of Parent/Guardian Attend School
Family Reasons Return to state following school attendance in another state
_____Yes _____No Have you attended a Georgia high school for at least one year?
_____Yes _____No Have you graduated or will you graduate from a Georgia high school?
_____Yes _____No Do you have a US state/territory-issued driver’s license or ID? If yes, in which state? ________
_____Yes _____No Do you own a moter vehicle? If yes, in which state is it registered? ________
_____Yes _____No Do you have a voter registration? If yes, in which state are you registered? ________
_____Yes _____No Did you le a state income tax return in the past year? If yes, in which state did you le? ________
I understand that as a Darton State College student, I may be photographed during events held on campus. I agree that my image may be pub-
lished and distributed in whole or in part for education, instructional, or promotional purposes in print or over open broadcast, cable, audiovi-
sual, radio, closed-circuit exhibition, or computer link. Said work will become the sole property of Darton State College, and I release Darton
State College from all claims based on said work.
I understand that any material false statement made knowingly and willingly by me on this application, or any documents attached hereto may,
in accordance with O.C.G.A. 16-10-71, which provides that upon conviction, a person knowingly commits the offense of false swearing shall
be punished by a ne of not more than $1,000 or by imprisonment for not less than one nor more than ve years, or both, subject to prosecution
in a court of law. Additionally, I further understand that any such false statement may subject me to immediate dismissal from the institution.
Further, I certify that, to the best of my knowledge, the information submitted on this application is true and complete.
Signature _____________________________________________________________ Date ____________________________________________
App Re-Admission (Update 06-20-12).indd 2 6/21/12 8:29 AM
