*Notice: This form is used by the Iowa College Student Aid Commission to determine eligibility for state-funded scholarship and
grant programs. This form is NOT used to determine a student’s residency for the purpose of tuition charges at postsecondary
The Iowa College Student Aid Commission (ICSAC) requests this information to determine your residence classification. If you fail to
provide the required information, the Commission may not act on this application. Return this form to your school’s financial aid office.
If you have always been a resident of Iowa and have never established domicile in another state, please contact the financial aid office at
the college you are/will be attending for further instructions.
The following section must be filled out completely. If any item in this section is left blank it will cause your application to be denied.
1. Full Legal Name:
Last First Middle
2. Social Security Number 3. Date of Birth:
4. For what semester or term are you applying for residency?
5. What Iowa college/university will you be attending?
6. Where were you born? (City, State)
7. Date you moved (or returned) to Iowa
8. If former Iowa resident, when did you leave?
Why did you leave Iowa?
9. Reason for coming to Iowa
10. Who moved to Iowa with you? _________________________________________________________________
11. Briefly explain your activities since you arrived in Iowa (Jobs, etc.-Give exact dates).
Describe your sources of financial support (job, spouse, parents, etc).
13. Gender: M F
14. Independent or Dependent student as determined by FAFSA: _________________
15. Parents state of legal residence (only applicable if a dependent student): __________________________
16. Current Address:
Number and Street (or Rural Route) City State Zip Code
17. Do you: Rent your home? Own your home?
18. Permanent Home Address
Number and Street (or Rural Route) City State Zip Code
19. When/where have you attended college in Iowa in the past (if at all)?
College: _________________________ Dates attended: _________________ Credit Hours: ____|____|____
Fall Spring Summer
College: _________________________ Dates attended: _________________ Credit Hours: ____|____|____
Fall Spring Summer
College: _________________________ Dates attended: _________________ Credit Hours: ____|____|____
Fall Spring Summer
20. How long do you intend to live in Iowa? _________________________________________________________
21. If married, give full name of husband or wife
(a) Date of marriage
(b) Was spouse resident of Iowa at date of marriage?
(c) Is spouse currently enrolled in college? Yes No
If yes, what is the name of the college?_________________________
(d) Is your spouse enrolled full time or part time? FT PT
(e) Did you move because you or your spouse took full-time employment in the state of Iowa? Yes No
If yes, briefly explain
(f) If married, when did your spouse begin working in Iowa?
(g) Does he/she work FT PT
(h) Spouses current hourly wage. $ ________________
22. What relative(s) do you have in Iowa? (list, i.e: mother, father, grandparents)
23. What is your current job, hours, and rate of pay?
Title Name of Company Stated Pay Hours per Week
24. For last year, in what state did you file your income tax return?
25. If you did not file an Iowa tax return, explain why.
26. In what state is your auto registered?
27. Do you have an Iowa Drivers License?
Yes No
If yes, list your license number:
28. Are you registered to vote in the state of Iowa? ___________________________________________________
A student who gives incorrect or misleading information on this form shall be unconditionally
disqualified for Iowa Resident Classification.
I certify that the information on this Application for Iowa Resident Classification and attached statements are correct. I
authorize the Iowa College Student Aid Commission to access enrollment history information from the National Student
Loan Data System (NSLDS) on my behalf.
Date Signature
The information provided on this form is consistent with admissions data
that we have received for this student.
___________________________________________ ________________________________________
Date Signature
: Do you support this student’s claim of being an Iowa resident?
**Return this form to your school’s Financial Aid Administrator**
click to sign
click to edit
click to sign
click to edit