College Residency Application
2700 Evergreen Parkway NW Olympia, WA 98505
Directions: Please print clearly and answer each question. Incomplete or illegible forms cannot be considered and will be returned. Falsification or intentionally erroneous information is
subject to perjury under the laws of the State of Washington, RCW 9A.72.085. All information will be kept confidential in accordance with the Family Educational Rights and Privacy Act of
1974. Once a domicile is established in Washington, it must continue for one year before you are eligible for resident tuition.
Complete form in full and attach required
documentation.
SECTION 1
Name (Last, First, MI)
Phone Number
FOR OFFICE USE ONLY
Type
Address (Street, State, Zip)
DEP INDEP
E-mail Address
Birth City, State, Country Birth Date
Today's Date
1. Last High School Attended _________________________________________ State ___________ Year Graduated _____________
Effective Date
2. For what term are you now seeking
residence classification? Year 20___
Fall Winter Spring Summer
If you have previously applied at this institution for a change in residence status, indicate: Term __________ Year __________
Resident Non-Resident
3. Class Standing:
Undergraduate Graduate Professional School: _______________________________________
____________________________________
Residence Classification Officer
4. At this Institution, you are or will be enrolled as a: New Student Continuing Student Returning Former Student
If continuing or former student, give number of credit hours for which you were registered during each of the last three terms and identify each term by session and year:
Credits ______ Term __________ Year __________ | Credits _______ Term __________ Year ___________ | Credits _______ Term __________ Year __________
5. Country of citizenship:
If not USA, answer 5a, 5b and 5c. If yes to 5a, 5b or 5c, attach a copy of
your U.S. Permanent Resident card, Form I-94 or other immigration
documentation.
5b. Do you hold "Refugee-Parolee," "Conditional Entrant" or PRUCOL status?
Yes No
Note: An immigrant refugee, and the spouse and dependent children of such refugee, may be
exempted from paying the nonresident tuition fees differential if the refugee (a) is on parole
status, (b) has received an immigrant visa, or (c) has applied for U.S. citizenship.
5a. Do you hold permanent or temporary resident immigration status?
Yes No
5c. Do you hold a visa classification of A, E, G, I or K?
Yes No
6. Have you received financial assistance from a state governmental unit or
agency during the past twelve months?
Yes No
If yes, indicate state, agency, type of assistance, disbursement dates, etc.
7. Will you be receiving state financial assistance during the next twelve months?
Yes No
If yes, indicate state, agency, type of assistance, disbursement dates, etc.
SECTION 2
1. Are you applying for resident status as a dependent
student whose parent or court -appointed legal guardian
has maintained a bona fide domicile in the State of
Washington for at least one year?
Yes No
If yes, your parent or legal guardian must complete SECTION 3 of this form, providing proof of his/her
Washington domicile and all requested supporting documentation. Verification of your dependent status
must be documented by submitting a true and correct copy of your parent's or legal guardian's state and
federal income tax return for the most recent tax year. The extent of the disclosure required concerning
the parent's or legal guardian's state and federal tax returns is limited to the listing of dependents claimed
and the signature of the taxpayer and shall not require disclosure of financial information contained in the
returns.
2. Are you applying for resident status as a financially
Independent student?
Yes No
If yes, you must complete Section 3 of this form and provide all requested supporting documentation.
2a. Student's Sworn Statement:
I have not been and will not be claimed as an exemption for federal Income tax purposes by any person except myself or my spouse for the current calendar year and for the
calendar year immediately prior to the year in which this application is made; and I have not received and will not receive significant financial assistance in any form directly
or indirectly from parents, relatives, legal guardians or others for the current year and for the calendar year immediately prior to the year in which this application is made.
Signature _________________________________________________________________________________________________ Date ___________________________
2b. To further substantiate your financial Independence, you are required to submit appropriate documentation , including but not limited to:
A true and correct copy of your state and federal income tax return for the calendar year immediately prior to the year in which this application is made. If you did not file a state
or federal income tax return because of minimal or no taxable income, documented information concerning the receipt of such nontaxable income must be submitted.
A true and correct copy of your W2 forms filed for the previous calendar year.
Other documented financial resources, which may include but are not limited to, the sale of personal or real property, trust fund, state or financial assistance, gifts, loans or
earnings of the spouse of a married student.
If you are 24 or younger, provide a true and correct copy of the first and signature page of the state and federal tax return of your parents, legally appointed guardians, or person
or persons who have legal custody of you for the calendar year immediately prior to the year in which this application is made. The extent of the disclosure required concerning
the parent's or legal guardian's state and federal tax returns is limited to the listing of dependents claimed and the signature of the taxpayer and shall not require disclosure of
financial information contained in the returns
.
