Fill - Free fillable Border State Waiver Application Application for Border State Waiver PDF form

Albany State University

APPLICATION FOR BORDER STATE WAIVER

(Alabama, Florida, South Carolina & Tennessee ONLY)

TUITION DIFFERENTIAL WAIVER

Prior to submitting a Border State Residents out-of-state tuition waiver application, students are advised to review the University

System of Georgia Border State Residents out-of-state tuition waiver policy found in Section 7.3.4.1 of the Board of Regents

Policy Manual (www.usg.edu/policymanual). Please note that the Border State Residents out-of-state tuition waiver is available

to qualifying undergraduate students only. Documentation must be provided with application.

Section I – To be completed by the STUDENT

Name:

Student ID:

Address:

City:

State:

Zip:

Email:

Phone:

Term applying for waiver: Fall Spring Summer

Year:

Will you be attending as an Yes No

undergraduate student?

Citizen Status:

U.S. Citizen

U.S. Permanent Resident

Nonresident Alien

Other:

This waiver application is based on your present and permanent home (domicile) in the following eligible state (Alabama, Florida, South

Carolina) bordering Georgia:

State:

Will you have lived in the above state for at least 12 consecutive months immediately preceding the first day of classes for the term the

waiver is requested? Yes No

Have you graduated or will you graduate from a high school in the above state? Yes No

Have you ever lived outside of the above state above? Yes No

If Yes: The above has been your state of domicile since: (mm/yyyy)

Briefly describe your reason for moving to the above state:

Do you hold a current driver’s license/state-issued ID? Yes No State issued?

Do you own a motor vehicle? Yes No State registered?

Are you registered to vote? Yes No State registered?

Did you file a state income tax return for the most

recent tax year?

Yes No State filed?

Employment Information – Please list all employment for the past two years, including military service. Attach additional sheets if needed.

From To Employer City State # of hours worked per week

Students under the age of 24 must complete the following:

Do you have a parent or U.S. court-appointed legal guardian who has established and maintained domicile in an eligible state (Alabama,

Florida, South Carolina) bordering Georgia for at least 12 consecutive months immediately preceding the first day of classes for the term

the waiver is requested? Yes No State:

If Yes:

Name of the above individual:

Relationship: Parent U.S. court-appointed legal guardian

Has that individual ever lived outside of the above state? Yes No

If Yes:

They have maintained domicile in the above state since: (mm/yyyy)

Briefly describe their reason for moving to the above state:

Rev. 07/2018

Do they hold a current driver’s license/state-issued ID? Yes No State issued?

Do they own a motor vehicle? Yes No State registered?

Are they registered to vote? Yes No State registered?

Did they file a state income tax return for the most recent tax year? Yes No

If Yes:

State filed? Were you claimed as a dependent? Yes No

Did they file a federal income tax return for the most recent tax year? Yes No

If Yes: Were you claimed as a dependent? Yes No

Section II – STUDENT Oath and Affirmation/Notary Oath and Affirmation – Sign in the presence of a Notary

I understand that any material false statement made knowingly and willingly by me on this application, or any documents attached hereto

may, in accordance with O.C.G.A. 16-10-71, which provides that upon conviction, a person who knowingly commits the offense of false

swearing shall be punished by a fine of not more than $1,000 or by imprisonment for not less than one nor more than five years, or both,

subject me to prosecution in a court of law. Additionally, I further understand that any such false statement may subject me to immediate

dismissal from the institution.

Further, I certify that, to the best of my knowledge, the information submitted on this application is true and complete.

Student Signature Date

STATE OF ____________________________

COUNTY OF ____________________________

The foregoing instrument was acknowledged before me this __________ day of ___________________, 20__________,

By ___________________________________________ (individual applying for Tuition Waiver)

__________________________________________________

Signature of Notary Public

State of ____________________________________________

___________________________________________________

Name of Notary Typed, Printed or Stamped

Notary Seal

Personally known ____________ or produced Identification __________________

___________________________________________________________________

Type of Identification Produced

Rev. 07/2018

Section III –Notary Oath and Affirmation Documentation Requirements

LAWFUL PRESENCE IN THE UNITED STATES

Only those students verified to be lawfully present in the United States may be considered for an out-of-state tuition waiver. Waiver

applicants may be required to provide additional documentation to meet this requirement. One of the following must be submitted:

• A certified US Birth Certificate showing the student was born in the U.S. or a U.S. Territory. (A photocopy or faxed copy is not

acceptable)

• A U.S. Certificate of Naturalization (USCIS form N-550 or N-570)

• A U.S. Certificate of Citizenship (USCIS form N-560 or N-561)

• A U.S. Certificate of Birth Abroad issued by the Department of State (DS-1350) or a Consular Report of Birth Abroad (FS-240).

• A current military ID (service member only, not dependent)

• A current, valid permanent resident card (USCIS form I-151 or I-551). Must have copy of the front and back of the card.

• A current U.S. Passport

DOCUMENTATION OF WAIVER ELIGIBILITY

Additional documentation is also required to confirm domicile in the border state such as the following:

• Copy of lease agreement or warranty deed (dated 12+ months)

• Copy of driver’s license or state-issued ID

• Copy of vehicle registration

• Copy of state tax return filed for the most recent tax year

• Copy of federal tax return filed for the most recent tax year

• Copy of utility bills

By Mail: By Email: (Preferred)

Office of Academic Services & Registrar tco@asurams.edu

Atten: Tuition Classification Officer Subject: ATTN: Border State Waiver

Albany State University

2400 Gillionville Road

Albany, GA 31707

Forms and documentation should be submitted as a completed packet at least 4 weeks prior to classes beginning.

Fill Online, Printable, Fillable, Blank Border State Waiver Application Application for Border State Waiver Form

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Fillable Border State Waiver Application Application for Border State Waiver

Fill Online, Printable, Fillable, Blank Border State Waiver Application Application for Border State Waiver Form

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