When do you consider that your West Virginia residency began?
Do you own real property (i.e. land, home, etc.) in West Virginia? Yes No
Are you presently married? Yes
If yes, does your spouse meet residency requirements as outlined in the University’s
guidelines? Yes No
Are you currently registered to vote in West Virginia? Yes
If yes, when did you
Do you possess a valid photo identification (driver’s license or non-driver ID) issued by the State of West Virginia? Yes No
Do you own a vehicle that is currently registered in West Virginia? Yes No
List the names and addresses of all of your employers for the last
Have you filed a West Virginia state personal income tax return? Yes
If yes, for which years
Did your parent(s) or guardian(s) claim you as a dependent on their most recent tax return? Yes No
What percentage of your tuition and living expenses is paid by your parent(s) and/or supporting person(s)? %
Section IV: U.S. Military Members and Veterans
(If you are not a veteran or current member of the military,
please leave this section blank.)
Are you currently an active duty member of the U.S. military? Yes
If yes, please specify branch and current
Have you previously served on active duty for a period of at least two years? Yes
If yes, were you honorably discharged?
Please list your separation date from active duty status:
Are you a current member of the West Virginia National Guard?
If yes, what month and year did you join?
Are you currently a member of a reserve component of the U.S. military? Yes
If yes, what month and year did you
become a reservist?
Have you been assigned a service-connected disability by the United States Department of Veteran Affairs? Yes No
If yes, please include documentation with this application.
Section V: Please provide legible copies of all documentation that verifies the information provided in this
I do solemnly swear/affirm that the statement and evidence hereby presented in support of the foregoing
application are true and
correct; and, furthermore, certify that the permanent address listed in Section I above is my residence and that I
intend to remain at that address
indefinitely, and that I have more substantial connections with the State of West Virginia than with any other state.
Signature of Applicant
SWORN TO AND SUBSCRIBED BEFORE ME THIS THE DAY OF , 20 .
My Commission Expires: