Adopted January 2012
Revised Chart II
Documentation to Support Establishing and Maintaining Domicile in Texas
The following documentation may be requested by the institution regarding a person’s
responses to the Core Residency Questions. Documents that may be used as proof that:
(1) The person or the dependent’s parent established domicile in Texas, and
(2) The person or the dependent’s parent has maintained domicile in Texas continuously for at least 12
consecutive months immediately preceding the census date of the term in which the person enrolls,
include but are not limited to the following:
Part A
Documents that may Support the Establishment of Domicile in Texas and
Maintenance of Domicile in Texas
1. SIGNIFICANT GAINFUL EMPLOYMENT
a. An employer’s statement of dates of employment in Texas (beginning and current or ending dates) that
encompass at least 12 consecutive months immediately preceding the census date of the term in which
the person enrolls. However, employment conditioned on student status, such as work study, the receipt
of stipends, fellowships, or research or teaching assistantships does not constitute gainful employment.
b. Other documents that show the person or the dependent’s parent, for at least 12 consecutive months
immediately preceding the census date of the term in which the person enrolls:
1) has been engaged in employment intended to provide an income to the person or allow the person to
avoid the expense of paying another to perform tasks (as in child care) that is sufficient to provide at
least one-half of the individual’s tuition and living expenses or represents an average of at least 20
hours per week; or
2) is self-employed in Texas or is living off his/her earnings; or
3) is primarily supported by public assistance in Texas.
c. For a person living on public assistance, written statements from the office of one or more social service
agencies located in Texas that attest to the provision of services to the person for the 12 consecutive
months immediately preceding the census date of the term in which the person enrolls.
2. SOLE OR JOINT MARITAL OWNERSHIP OF RESIDENTIAL REAL PROPERTY
Title to residential real property in Texas with documentation to verify 12 consecutive months of ownership
immediately preceding the census date of the term in which the person enrolls, such as a Warranty Deed, with
the person or the dependent’s parent having established and maintained domicile at that residence.
3. MARRIAGE TO A PERSON WHO HAS ESTABLISHED AND MAINTAINED DOMICILE IN TEXAS
Marriage Certificate or Declaration of Registration of Informal Marriage with documentation to support that
spouse has established and maintained domicile in Texas for the 12 consecutive months preceding the census
date of the term in which the person enrolls.
4. OWNERSHIP OF A BUSINESS ENTITY
Documents that evidence the organization of the business in Texas that reflect the ownership interest of the
person or dependent’s parent, and the customary management of the business by the person or dependent’s
parent without the intention of liquidation for the foreseeable future.
Part B
Documents that May Provide Support to a Claim of Residence in Texas for the 12
Consecutive Months Immediately Preceding the Census Date of the Term in which
the Person Enrolls
1. Utility bills for the 12 consecutive months preceding the census date;
2. A Texas high school transcript for full senior year immediately preceding the census date;
3. A transcript from a Texas institution showing presence in the state for the 12 consecutive months preceding
the census date;
4. A Texas driver’s license or Texas ID card that has not expired and, if it reflects an origination date, shows
an origination date at least 12 months prior to the census date;
5. Cancelled checks that reflect a Texas residence for the 12 consecutive months preceding the census date;
6. A current credit report that documents the length and place of residence of the person or the dependent’s
parent to be in Texas and the length of residence to be at least 12 consecutive months preceding the census
date.
7. Texas voter registration card that was issued at least 12 months prior to the census date.
8. Pay stubs for the 12 consecutive months immediately preceding the census date, reflecting significant
gainful employment in Texas;
9. Bank statements reflecting a Texas address for the 12 consecutive months immediately preceding the
census date;
10. Written statements from the office of one or more social service agencies, attesting to the provision of
services for at least the 12 consecutive months immediately preceding the census date.
11. Lease or rental of residential real property in the name of the person or the dependent’s parent for the 12
consecutive months immediately preceding the census date.
Part C
Other Documents that May be Used to Lend Support To or Clarify
an Individual’s Claim of Domicile or Residence, as Appropriate, in Texas
Among other documents that may be used to lend support to or clarify an individual’s claim of
having established and maintained domicile or residence, as appropriate, in Texas are the
following:
1. Tax return of the student or parent(s).
2. Visa, passport or other pertinent immigration documents.
3. Leave and Earnings Statements (LES).
4. Documents or statements to clarify answers to Core Residency Questions.
5. A Texas high school transcript to verify thirty-six months’ presence in the state and graduation from a Texas
high school.
6. State of Texas or local (Texas) licenses to conduct a business or practice a profession in this state.
Adopted January 2012
February 2011
1
Core Residency Questions
Texas Higher Education Coordinating Board rule 21.25 requires each student applying to enroll
at an institution to respond to a set of core residency questions for the purpose of determining
the student’s eligibility for classification as a resident.
PART A. Student Basic Information. All Students must complete this section.
Name: Student ID Number:
Date of Birth:
PART B. Previous Enrollment. For all students.
1. During the 12 months prior to the term for which you are applying, did you attend a public
college or university in Texas in a fall or spring term?
Yes ___ No ___
If you answered “no”, please continue to Part C.
If you answered “yes”, complete questions 2 - 5:
2. What Texas public institution did you last attend? (Give full name, not just initials.)
_________________________________________________
3. In which terms were you last enrolled? (check all that apply)
___ fall, 20__ ___ spring, 20__
4. During your last semester at a Texas public institution, did you pay resident (in-state) or
nonresident (out-of-state) tuition?
___ resident (in-state) ___ nonresident (out-of-state) ___ unknown
5. If you paid in-state tuition at your last institution, was it because you were classified as a
resident or because you were a nonresident who received a waiver?
___ resident ___ nonresident with a waiver ___ unknown
IMPORTANT: If you were enrolled at a Texas public institution during a fall or spring semester
within the previous 12 months and were classified as a Texas resident, skip to Part I, sign and
date this form and submit it to your institution. If you were not enrolled, or if you were enrolled
but classified as a nonresident, proceed to Part C.
PART C. Residency Claim.
Are you a resident of Texas? Yes ___ No ___
If you answered yes, continue to Part D.
If you answered no, complete the following question and continue to Part I.
Of what state or country are you a resident? __________________
If you are uncertain, continue to Part D.
February 2011
2
PART D. Acquisition of High School Diploma or GED.
Yes
No
1. a. Did you graduate or will you graduate from high school or complete a
GED in TX prior to the term for which you are applying?
1. b. If you graduated or will graduate from high school, what was the name
and city of the school?
2. Did you live or will you have lived in TX the 36 months leading up to high
school graduation or completion of the GED?
3. When you begin the semester for which you are applying, will you have
lived in TX for the previous 12 months?
4. Are you a U.S. Citizen or Permanent Resident?
Instructions to Part D:
If you answered “no” to question 1a or 2 or 3, continue to Part E.
If you answered “yes” to all four questions, skip to Part I.
If you answered “yes” to questions 1, 2 and 3, but “no” to question 4, complete a
copy of the Affidavit in Chart I, provided as an Attachment to this form, skip to
Part I of this form, and submit both this form and the affidavit to your institution.
PART E. Basis of Claim to Residency. TO BE COMPLETED BY EVERYONE WHO DID
NOT ANSWER “YES” TO QUESTIONS 1a, 2, AND 3 OF PART D.
1. Do you file your own federal income tax as an independent tax payer? Yes___ No ___
(An independent tax payer should not be claimed as a dependent for tax purposes by another
person. If you file a joint return with your spouse, answer “yes.”)
2. Are you claimed as a dependent or are you eligible to be claimed as a dependent by a
parent or court-appointed legal guardian? Yes___ No ___ (To be eligible to be claimed as a
dependent, your parent or legal guardian must provide at least one-half of your support. A step-
parent does not qualify as a parent if he/she has not adopted the student.)
3. If you answered “No” to both questions above, who provides the majority of your support?
Self___ parent or guardian___ other: (list)______________________
Instructions to Part E.
If you answered “yes” to question 1, and “no” to question 2, continue to Part F.
If you answered “yes” to question 2, skip to Part G.
If you answered “yes” to both questions 1 and 2, skip to Part G.
If you answered “no” to 1 and 2 and “self” to question 3, continue to Part F.
If you answered “no” to 1 and 2 and “parent or guardian” to question 3, skip to Part G.
If you answered “no” to 1 and 2 and “other” to question 3, skip to Part H and provide an
explanation, and complete Part I.
February 2011
3
PART F. Questions for students who answered “Yes” to Question 1 or “Self” to Question
3 of PART E.
Yes
No
Years
Mo.
Visa/Status
1. Are you a U.S. Citizen?
2. Are you a Permanent Resident of the U.S.?
3. Are you a foreign national whose application
for Permanent Resident Status has been
preliminarily reviewed? (You should have
received a fee/filing receipt or Notice of Action
(I-797) from USCIS showing your I-485 has
been reviewed and has not been rejected).
4. Are you a foreign national here with a visa or
are you a Refugee, Asylee, Parolee or here
under Temporary Protective Status? If so,
indicate which.
5. Do you currently live in Texas? If you are out
of state due to a temporary assignment by your
employer or another temporary purpose, please
check “no” and explain in Part H.
Yes
No
6. a. If you currently live in Texas, how long
have you been living here?
b. What is your main purpose for being in the
state? If for reasons other than those listed,
give an explanation in Part H.
Months
Years
Go to
College
[ ]
Establish/maintain
a home
[ ]
Work
Assignment
[ ]
7. a. If you are a member of the U.S. military, is
Texas your Home of Record?
b. If not, what state will have been listed as
your military legal residence for tax purposes on
your Leave and Earnings Statement for the 12
months prior to enrollment?
Yes
No
State
Yes
No
8. Do any of the following apply to you? (Check all that apply)
a. Hold the title (Warranty Deed, Deed of Trust, or other similar
instrument that is effective to hold title) to residential real property
in Texas?
If yes, date acquired: ________________________
b. Have ownership interest and customarily manage a business
in Texas without the intention of liquidation in the foreseeable
future?
If yes, date acquired: ________________________
AL
February 2011
4
9. While living in Texas, have you: (Check all that apply)
a. Been gainfully employed for a period of at least 12 consecutive
months? (Gainful employment requires an average employment
of at least 20 hours per week for one year or earnings equal to at
least half of tuition and living expenses for one 9-month
academic year. Employment conditioned on student status such
as work-study, the receipt of stipends, fellowships or research or
teaching assistanceships does not constitute gainful
employment.)
b. Received primary support through services from a social
service agency for a period of at least 12 consecutive months?
10.
a. Are you married to a person who has been classified as a Texas
resident by a Texas public institution or who could answer “yes” to
any part of question 8 or 9?
b. If yes, indicate which question (and which part of the question)
could be answered yes by your spouse:
c. How long will you have been married to the Texas resident prior
to enrollment?
Question:
Months
Years
Skip Part G and Continue to Part H.
PART G. Questions for students who answered “Yes” to Question 2 of Part E or who
answered “Parent or Guardian” to Question 3 of PART E.
Yes
No
Years
Mo.
Visa/Status
1. Is the parent or legal guardian upon whom you
base your claim of residency a U.S. citizen?
2. Is the parent or legal guardian upon whom you
base your claim of residency a Permanent
Resident?
3. Is this parent or legal guardian a foreign
national whose application for Permanent
Resident Status has been preliminarily reviewed?
(He or she should have received a fee/filing
receipt or Notice of Action (I-797) from the USCIS
showing his or her I-485 has been reviewed and
has not been rejected)
4. Is this parent or legal guardian a foreign
national here with a visa or a Refugee, Asylee,
Parolee or here under Temporary Protective
Status? If so, indicate which.
February 2011
5
5. Does this parent or guardian currently live in
Texas? If he or she is out of state due to a
temporary assignment by his or her employer or
another temporary purpose, please check “no”
and explain in Part H.
6. a. If he or she is currently living in Texas, how
long has he or she been living here?
b. What is your parent’s or legal guardian’s
main purpose for being in the state? If for
reasons other than those listed, give an
explanation in Part H.
Months
Years
Go to
College
[ ]
Establish/maintain
a home
[ ]
Work
Assignment
[ ]
7. a. If he or she is a member of the U.S. military,
is Texas his or her Home of Record?
b. If not, what state will have been listed as his
or her military legal residence for tax purposes on
his or her Leave and Earnings Statement for the
12 months prior to enrollment?
State
Yes
No
8. Do any of the following apply to your parent or guardian? (Check all
that apply)
a. Hold the title (Warranty Deed, Deed of Trust or other similar
instrument that is effective to hold title) to residential real property in
Texas?
If yes, date acquired: ________________________
b. Have ownership interest and customarily manage a business In
Texas without the intention of liquidation in the foreseeable future?
If yes, date acquired: ________________________
9. While living in Texas, has your parent or guardian: (Check all that
apply)
a. Been gainfully employed for a period of at least 12 consecutive
months? (Gainful employment requires an average employment of at
least 20 hours per week for one year or earnings equal to at least half of
tuition and living expenses for one 9-month academic year.
Employment conditioned on student status such as work-study, the
receipt of stipends, fellowships, or research or teaching assistanceships
does not constitute gainful employment.)
b. Received services from a social service agency for a period of at
least 12 consecutive months? Note: the dollar value of social services
received may be combined with earnings to total at least one-half of
tuition and living expenses for one 9-month academic year.
AL
February 2011
6
10.
a. Is your parent or legal guardian married to a person who has been
classified as a Texas resident by a Texas public institution or who could
answer “yes” to any part of question 8 or 9?
b. If yes, indicate which question (and which part of the question) could
be answered yes by your parent or guardian’s spouse:
c. How long will your parent or guardian have been married to the Texas
resident prior to enrollment?
Question:
Months
Years
Part H. General Comments. Is there any additional information that you believe your
college/university should know in evaluating your eligibility to be classified as a resident? If so,
please provide it below:
February 2011
7
PART I. Certification of Residency. All students must complete this section.
I understand that officials of my college/university will use the information submitted on
this form to determine my status for residency eligibility. I authorize the college/university to
verify the information I have provided. I agree to notify the proper officials of the institution of
any changes in the information provided. I certify that the information on this application is
complete and correct and I understand that the submission of false information is grounds for
rejection of my application, withdrawal of any offer of acceptance, cancellation of enrollment
and/or appropriate disciplinary action.
Signature: _______________________________ Date: ________________
February 2011
8
AFFIDAVIT
STATE OF TEXAS §
§
COUNTY OF ________________ §
Before me, the undersigned Notary Public, on this day personally appeared
__________________________________________________________________,
known to me, who being by me duly sworn upon his/her oath, deposed and said:
1. My name is ________________________________________________________. I am
___ years of age and have personal knowledge of the facts stated herein, and they are all true
and correct.
2. I graduated or will graduate from a Texas high school or received my GED certificate in
Texas.
3. I resided in Texas for three years leading up to graduation from high school or receiving my
GED certificate.
4. I have resided or will have resided in Texas for the 12 months prior the census date of the
semester in which I will enroll in ___________________________________
(college/university).
5. I have filed or will file an application to become a permanent resident at the earliest
opportunity that I am eligible to do so.
In witness whereof, this ____________day of _______________________, _________.
___________________________________
(Signature)
_________________________________
(Printed Name)
___________________________________
(Student I.D.#)
SUBSCRIBED TO AND SWORN TO BEFORE ME, on the ___________________ day of
________________________________________, ___________________________, to certify
which witness my hand and official seal.
__________________________________
Notary Public in and for the State of Texas
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