2/15/2018 10:57 AM
Admissions & Records
Supplemental Residency Questionnaire
Request for Change in Residence Status
Nonresident Classification
You have been classified as a NON-RESIDENT of California for educational purposes and as such are subject to
nonresident tuition. Please read the information below.
As a non-resident student you will need to apply for re-classification of your residency status. This must be done in advance
of the term you wish to be considered for resident tuition purposes. Complete the Supplemental Residency
Questionnaire Form and submit it along with supporting documentation to the Admissions & Records office.
Establishing Residency
If you intend to become a resident of California, you must fulfill the requirements listed below:
For a person 19 years of age and older: (a) Continued physical presence in the state of California, (b) being under an
immigration status that allows you to establish residency and (c) having at least two proofs of intent in your own name.
All three of these requirements must be dated one year and one day prior to the residency determination date.
Note: If you are claimed as a dependent on your parents’ income tax returns filed in a state other than California, you
are NOT eligible to establish California residency.
For a person younger than 19 years of age (by the residency determination date): A minor takes the residency
of the parent (natural or adopted) with whom the minor last lived. Both the minor and the parent must be under a status
that allows establishment. The minor’s residency is derived from the parent. Physical presence and the two proofs of
intent will come from the parent.
Veterans and other qualifying individuals may be eligible for non-resident tuition fee exemption.
1
Status types under which a person may establish residency:
U.S. citizen, Refugee, Asylum, Permanent Resident, Temporary Protected Status, individuals approved under the
Deferred Action for Childhood Arrivals (DACA) program, certain non-immigrant visas: A, E, G, H1, H4, I, K1-4, L1-2,
N8-9, NATO-1, O1, O3, R1-2, T1-5, TPS, U, V. Documentation of status may be required. Certain Special Immigrant
Visas (SIVs) and refugees may be eligible for a ONE-year non-resident tuition exemption.
2
Types of Documents Required to Show Proof of Intent
You must provide THREE proofs of residency demonstrating physical presence and intent. Two of the three must be dated at least
one year and one day prior to the start of the term for which you are applying. These items must not be older than two years prior
to the start of the term. Examples of appropriate documentation include:
California voter’s registration card
California (540) tax returns giving California as the home address (with acceptable dates)
Paycheck stub OR letter of employment verification on company letterhead (signed by a manager of the personnel
department)
California Driver’s License OR California ID card OR DMV printout
California Bank account – checking or savings statements
Marriage license or divorce decree issued in California
License or certificate issued by the State (with issue and expiration dates)
California utility bill (gas, telephone, cable - all utility bills count as one proof)
California State Aid or Social Welfare
California vehicle registration and/or car insurance (California company)
California health insurance OR Medi-Cal ID
Military discharge papers (DD214) OR Leave & Earnings statement (indicating California as Home of Record)
California Property Taxes OR
Union membership in a California local
California apartment/home rental and/or lease agreement (1 year current)
California public library membership (verified by letter or printout with letterhead or branch stamp)

1
In2017,SB85wasenactedamendingEducationCodesection68075.7toexempteligible“coveredindividuals”frompayingnonresidenttuitiontoalignwiththeVACAact.
2
In2017,AB343wasenactedamendingEducationCodesection68075.6toallowanexemptiontononresidenttuitionforthosewhosettledinCaliforniauponenteringthe
U.S.
2/15/18 11:24 AM
Admissions & Records
Supplemental Residency Questionnaire
Request for Change in Residence Status
This form is to be completed if you are requesting a residency reclassification or wish to clarify your residency. The burden of proof to clearly
demonstrate both physical presence in California and intent to establish California residence lies with you in accordance with Education Code Section
68040 and RCCD Board Policy. Please read the information provided on the backside of this form and then answer the following questions that
apply to you. Please complete the form using BLACK OR BLUE INK ONLY.
______________________________________________________________ _________________________
Last Name First Name M.I. RCCD ID# or SSN
______________________________________ ______________________________ _____ ____________
Number and Street Apt# City State Zip
_______________ (_______)______________________ _________________________________________________
Date of Birth Phone Number RCCD Student Email Address
Term of Requested Change:
SUM____ FAL____ WIN____ SPR____
Currently enrolled in classes: YES NO
Parent/Guardian Status:
I am 19 or older and I am NOT claimed as a dependent on my parents’ last income tax returns.
I am 19 or older and I am claimed as a dependent on my parents’ last income tax returns filed in the state of __________.
Note: You are NOT eligible to establish California residency if claimed as a dependent on income tax returns filed outside of California.
I am under 19 AND unmarried. I will answer the following questions for my _________________________________.
Relationship, Name
Residence in California:
Indicate the date when you began residing in California. Do not include absences (such as vacations, etc.) which can be explained without conflicting
your residency: __________________________________
Month/Day/Year
Do you intend to maintain California as your legal state of residence? YES NO
Have you attended a California high school for three or more years? YES NO
Have you received a California high school diploma, GED, or certificate of completion? YES NO
Required Documentation:
You will need to attach documentation for THREE or more of the following activities to request a change of residency. If you are under 19, answer
for your parent/guardian. Two of the three activities must have been completed a year and a day prior to the start of the term for which you are
seeking residency. These items must not be older than two years prior to the start of the term.
DATES (Month/Day/Year)
California voter’s registration card
California (540) tax returns giving California as the home address (with acceptable dates)
Paycheck stub OR letter of employment verification on company letterhead (signed by manager of the personnel
department)
California Driver’s License OR California ID card OR DMV printout
California Bank account - checking or savings statemen
t
Marriage license or divorce decree issued in California
California utility bill (gas, telephone, cable - all utility bills count as one proof)
California vehicle registration and/or insurance (California company)
California Property Taxes OR California apartment/home rental and/or lease agreemen
t
Military discharge papers (DD214) OR Leave & Earnings statement (indicating California as Home of Record)
Other:
WARNING: Providing false information about your citizenship, military status, and/or California residency could result in criminal
charges for perjury and/or fraud, with the possibility of imprisonment if you are convicted.
Student Signature: ____________________________________________________ Date: _______________________
Citizenship Status:
US Citizen
Permanent Resident
Temporary Resident Other Status
Amnesty Refugee/Asylee Other Visa________ DACA
_____________________________________ ________________ ________________
Alien ID Number (if applicable) Issue Date Expiration Date
****************FOR OFFICE
USE ONLY****************
Approved: YES NO XASP Updated By: ________________ Date: ___________ Effective: SUM____ FAL____ WIN____ SPR____
NRW: AB 13 AB 343 Will expire one year from the date the student settled in California upon entering U.S.
click to sign
signature
click to edit