As set forth in full in the Student Handbook/Course Catalog, Southern Crescent Technical College is an Equal Opportunity Institution and does not discriminate on the basis of race, color,
national origin, sex, age or disability.
Revised 03-23-2020
2020-2021 Georgia Residency
Verification Worksheet
Please Type or Print clearly in BLUE or BLACK ink
Student’s Last Name Student’s First Name Student’s M.I. Southern Crescent Student ID #
____________________________________________________________
Student’s Street Address (include apt. no.) Student’s Date of Birth
____________________________________________________________
City State Zip Code Student’s Email Address
____________________________________________________________
Student’s Home Phone Number (include area code) Student’s Alternate or Cell Phone Number
In order to determine HOPE Scholarship/Grant Eligibility, additional documentation is needed to verify Residency. Please complete this form and
return 1.) A completed copy of your 2018 & 2019 State of Georgia Tax Return (if an Independent Student) or a completed copy of your Parent(s)
2018 & 2019 State of Georgia Tax Return (if considered a Dependent Student) and 2.) A copy of one of the following requested documents from the
list on the right below.
Please select which documents are included with this verification request form and return to the Office of Financial Aid as soon as possible to complete
the review of your application for Financial Aid.
NOTE: Georgia Student Finance Commission (GSFC) requires a period of established Georgia Residency.
A. PROVIDED RESIDENCY DOCUMENTATION
Dependent Student
☐ 2018 Parent's GA State Tax Return AND
☐ 2019 Parent's GA State Tax Return
☐ A copy of Father's GA Driver's License AND
☐ A copy of Mother's GA Driver's License
- OR -
☐ A copy of Father's GA Voter Registration Card AND
☐ A copy of Mother's GA Voter Registration Card
Independent
Student
☐ 2018 Student's GA State Tax Return AND
☐ 2019 Student's GA State Tax Return
☐ A copy of Student's GA Driver's License
- OR -
☐ A copy of Student's GA Voter Registration Card
B. ESTABLISHED RESIDENCY HISTORY
PARENT STUDENT
Current State of Legal Residence
Date you became a Resident (Month/Year) / /
Date of High School Graduation/GED
/
Name of Final High School
Location of the High School (City, State)
City: State:
Name of the first Georgia College or
U
i
ersity atten
e
afte
High School
Start Date of the Georgia College or
U
i
ersit
atten
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Mo
th/Yea
/
I certify that the information I am providing is true, complete, and correct to the best of my knowledge.
Student Signature: ___________________________________________ Date: _______________________________
Parent Signature (If Dependent):________________________________ Date: _______________________________
Locations
501VarsityRoad 1533Hwy19South 300LakemontDrive
Griffin,GA30223 Thomaston,GA30286 McDonough,GA30253
P:770‐228‐7368 P:706‐646‐6386 P:770‐467‐6049
F:770‐229‐3029 F:706‐646‐6063 F:770‐914‐4424
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