STUDENT I.D. NO.
Houston Community College
CHANGE OF RESIDENCY PETITION
IN ORDER TO GUARANTEE THAT A RESIDENCY CHANGE WILL BE MADE PRIOR TO THE PAYMENT OF FEES, THIS RESIDENCY PETITION AND ALL
SUPPORTING DOCUMENTS MUST BE PRESENTED TO THE APPROPRIATE CAMPUS OFFICIAL BEFORE REGISTRATION. PETITIONS
SUBMITTED AFTER REGISTRATION WILL BE EFFECTIVE FOR THE FOLLOWING TERM.
NAME
LAST FIRST M.I.
HOME ADDRESS
STREET APT. NO. CITY COUNTY STATE ZIP
1.
COMPLETE THIS SECTION IF YOU ARE PETITIONING FOR CHANGE FROM NON RESIDENT TO RESIDENT STATUS
BASIS FOR CHANGE (CHECK ONE)
VISA CHANGE NEW VISA TYPE __________________________________________
MET 12 MONTH RESIDENCY REQUIREMENT. (MUST BE CITIZEN, PERMANENT RESIDENT, OR HAVE
ELIGIBLE VISA CLASSIFICATION ACCORDING TO TEXAS EDUCATION CODE (54.052)
MILITARY (Statement of intent to establish residency in Texas).
OTHER _______________________________________________________________________________
NOTE: ATTACH COPIES OF ALL SUPPORTING DOCUMENTS
COMMENTS ________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
2.
COMPLETE THIS SECTION IF YOU ARE PETITIONING FOR CHANGE FROM OUT-OF -DISTRICT TO IN-DISTRICT RESIDENCY STATUS
IN WHAT SCHOOL DISTRICT DO YOU RESIDE? HISD STAFFORD ALIEF KATY
SPRING CY-FAIR
SPRING BRANCH
FORT BEND NORTH FOREST
PASADENA GALENA PARK
PEARLAND
CHANNELVIEW ALDINE
OTHER _____________________________________________________
INITIAL DATE OF RESIDENCY IN DISTRICT ________________________
THIS PETITION IS NOT VALID UNLESS SIGNED AND DATED AND ALL SUPPORTING DOCUMENTS ARE ATTACHED.
I UNDERSTAND THAT THE PURPOSE OF THIS PETITION IS TO SUBMIT INFORMATION FOR DETERMINATION OF RESIDENCY FOR TUITION
PURPOSES AT HOUSTON COMMUNITY COLLEGE. FALSE INFORMATION IS GROUNDS FOR RETROACTIVE PAYMENT OF NON-RESIDENT FEES OR
WITHDRAWAL FROM THE COLLEGE AND LOSS OF CREDIT.
________________________________________________ _________________________________________________
VERIFIED BY DATE
STUDENT SIGNATURE DATE
________________________________________________
CAMPUS
OFFICE USE ONLY
RES. ________________________
COUNTY _____________________
OFFICE USE ONLY
RES. ________________________
COUNTY _____________________
VISA ________________________
DATE ENTERED
With few exceptions, state law gives you the right to request, receive, review and correct information about yourself collected on this form.
FORM 200 (rev.7/18) MCSR18-4450
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