Virginia Military Institute Lexington, Virginia 24450-0304 Click here to view VMI’s Non-Discrimination Statement.
SECTION B — PARENT OR LEGAL GUARDIAN
1. Name of applicant _______________________________________________________________________________________________
2. Name of parent or legal guardian ____________________________________________________________________________________
3. Relationship to applicant____________________________________________________________________________________________
4. Citizenship: _____ U.S. _____ Non-U.S. If non-U.S., give visa type________________________________________________________
5. How long have you lived in Virginia? _________________________________________________________________________________
6. Where have you lived for the past two years? List current address first:
FROM TO
(mo/yr) (mo/yr) ADDRESS CITY STATE ZIP
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
7. Will you have filed a tax return or paid income taxes to any state other than Virginia during the past year? ___ Yes ___ No
If yes, which state? _________________________________________________________
8. Will you have claimed the applicant as a dependent on your federal and Virginia income tax returns
for the tax year prior to the term in which the applicant will enroll? ___ Yes ___ No
9. Will you have provided over half of the applicant’s financial support for at least one year prior
to the term in which the applicant will enroll? ___ Yes ___ No
10. For at least one year prior to the term in which the applicant will enroll, will you have
A. filed a tax return or paid income taxes to Virginia on all earned income? ___ Yes ___ No
B. been a registered voter in Virginia? ___ Yes ___ No If yes, give date______________________________
C. held a valid Virginia driver’s license? ___ Yes ___ No If yes, date issued___________________________
11. Do you own or operate a motor vehicle? ___ Yes ___ No
If yes, has it been registered in any state other than Virginia during the past year? ___ Yes ___ No
12. Are you or your spouse currently on active duty assigned to a permanent duty station in Virginia? ___ Yes ___ No
If yes, check: _____ self _____ spouse
If yes, is the applicant a “military dependent” of the family member currently on active duty assigned to a permanent duty station in Virginia?
___ Yes ___ No If yes, please provide the following items:
A. A copy of military orders verifying active duty military status and permanent duty station within Virginia
B. Documentation verifying Virginia residence
C. Copy of your military dependent card issued by the military
13. Were you a resident of the Commonwealth of Virginia and a member of the Foreign Service Oce who received a foreign service assignment?
___ Yes ___ No If yes, date of foreign service assignment: _________________________________
14. Answer this question only if you or your spouse live outside Virginia, but work in Virginia:
A. Will you or your spouse have lived outside Virginia, been employed in Virginia, earned at least $14,500,
and paid Virginia income taxes on all taxable income earned in this Commonwealth for at least one year
prior to the term in which the applicant will enroll? ___ Yes ___ No
B. If the answer to A is “Yes,” will the parent employed in Virginia have claimed the applicant as a dependent for
federal and Virginia income tax purposes for at least one year prior to the term in which the applicant will enroll? ___ Yes ___ No
I certify all the information provided is true.
Signature of parent or guardian____________________________________________________ Date _______________________________
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