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Career, Technical, Adult & Community Education

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Career, Technical, Adult & Community Education
Broward Technical Colleges
RESIDENCY AFFIDAVIT FOR TUITION PURPOSES
(CERTIFICATE & APPLIED TECHNOLOGY DIPLOMA STUDENTS ONLY)
A Florida “resident for tuition purposes” is a person who has, or a dependent person whose parent or legal guardian has,
established and maintained legal residency in Florida for at least twelve (12) consecutive months preceding the first day of classes
of the term for which Florida residency is sought.
• Residence in Florida must be a bona fide domicile rather than for the purpose of maintaining a residence incident to
enrollment at an institution of higher education.
• To qualify as a Florida resident for tuition purposes, you must be a U.S. citizen or foreign national in a nonimmigrant visa
classification that grants you the legal ability to establish a bona fide domicile in the United States, a permanent resident
alien, parolee, asylee, Cuban-Haitian entrant, legal alien granted indefinite stay by the U.S. Citizenship and Immigration
Services, or other qualified alien as defined under federal law. Other persons not meeting the twelve-month legal
residence requirements may be classified as Florida residents for tuition purposes only if they fall within one of the limited
special categories authorized by the Florida Legislature pursuant to section 1009.21, Florida Statutes (see “Qualification
by Exception” below). All other persons are ineligible for classification as a Florida “resident for tuition purposes.”
• Living in or attending school in Florida will not, in itself, establish legal residence. Students who depend upon out-of-
state parents for support are presumed to be legal residents of the same state as their parents.
• Residency for tuition purposes requires the establishment of legal ties to the state of Florida. A student must verify that
the student has broken ties to other states if the student or, in the case of a dependent student, his or her parent has
moved from another state.
Please print if submitting hard copy:
Name of Student: Date of Birth:
Student is a: U.S. Citizen Non-U.S. Citizen Permanent Resident Other
Alien Registration Number: Issue Date:
Visa Category
All non-U.S. citizen students seeking classification as a Florida resident for tuition purposes are required to submit documentation
of their legal status in the United States as issued by the United States Citizenship and Immigration Services office.
NON-FLORIDA RESIDENT
I do not qualify as a Florida resident for tuition purposes for the term for which this application is submitted. I understand that
should I qualify for a future term, it will be necessary for me to submit an updated Residency Declaration while providing prescribed,
supporting documentation to substantiate as “reclassification” of my status. I understand being classified as a non-Florida resident
will not exclude me from the possibility of receiving a waiver to cover part or all of the out-of-state fee as defined in s. 1009.26,
Florida Statutes. Submission of an updated Residency Declaration must occur prior to the beginning of the term for which residency
is sought. I do not have to complete any further portion of this form, with the exception of signing below.
Student Name:
Signature of Student: (Electronic or ink): Date:
IF 036-WEIM rev. 6/27/18-daa page 1 of 4
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TO BE COMPLETED BY THE STUDENT SEEKING FLORIDA RESIDENCY FOR TUITION PURPOSES:
I qualify as a resident for tuition purposes, as defined by s. 1009.21, Florida Statutes, for the term for which this application is
submitted. I understand that it will be necessary for me to present evidence of residency for tuition purposes, supporting my claim
as a Florida resident for tuition purposes. I have read the residency information on qualifying as a dependent or independent
student, and declare that: (select one of the options below):
I am a dependent student, as defined by s. 1009.21(1)(a). Florida Statutes, in that I am eligible to be claimed as a dependent
under the federal income tax code by the claimant below. The claimant is my “parent” as defined by s. 1009.21(1)(f), Florida
Statutes, (i.e., either or both parents of the student, any guardian of a student, or any person in a parental relationship to the
student). My parent has maintained legal residence in Florida for a least the past 12 consecutive months. As defined by
section 1009.21(1)(d), Florida Statutes, “’legal resident’ or ‘resident’ means a person who has maintained his or her residence
in this state for the preceding year, has purchased a home which is occupied by him or her as his or her residence, or has
established a domicile in this state pursuant to s.222.17.” A copy of your parent’s tax return may be requested to establish
dependence.
I am an independent person who has maintained legal residence in Florida for at least the past 12 consecutive months. I
provide more than 50% of my own support. An independent student generally includes a person who is at least 24 years old,
married, a graduate or professional student, a veteran, a member of the armed forces, a ward of the court, or someone with
legal dependents other than a spouse, pursuant to the United States Department of Education for the purposes of federal
financial aid eligibility. There may be limited cases where a person under the age of 24 years old may qualify as an
independent student. Such students will be required to verify independence (including financial independence.) A copy of
your tax return may be requested to establish independence.
I meet residency requirements through one of the Qualifications by Exception below (check appropriate exception):
QUALIFICATION BY EXCEPTION (to be completed by the student.)
As provided in s. 1009.21, Florida Statutes, I qualify for residency based on the following permitted exception (documentation
required):
I am a qualified beneficiary under the terms of the Florida Prepaid College Program (s. 1009.98, Florida Statutes.) (Required:
Copy of Florida Prepaid Recipient card.)
I am married to a person who has maintained legal residence in Florida for at least the past 12 consecutive months. I now
have established legal residence and intend to make Florida my permanent home. (Required: copy of marriage certificate
and/or other documents required to establish residency.)
I was previously enrolled at a Florida state postsecondary institution and classified as a Florida resident for tuition purposes.
I am transferring to another Florida state postsecondary institution within 12 months of the previous enrollment. (Required:
Evidence of previous enrollment as a FL resident)
I was previously enrolled at a Florida state postsecondary institution and classified as a Florida resident for tuition purposes.
I abandoned my Florida domicile less than 12 months ago and am now re-establishing Florida legal residence.
Active duty members of the Armed Services of the United States residing in this state and their spouses and dependent
children, and active drilling members of the Florida National Guard. (Required: Copy of military orders or DD2058 showing
home of record.)
Active duty members of the Armed Services of the United States and their spouses and dependents attending a Florida
College System institution or state university within 50 miles of the military establishment where they are stationed, if such
military establishment is within a county contiguous to Florida. (Required: Copy of military orders.)
IF 036-WEIM rev. 6/27/18-daa
page 2 of 4
(if upon birth, enter birthdate):
United States citizens living on the Isthmus of Panama, who have completed 12 consecutive months of college work at the
Florida State University Panama Canal Branch, and their spouses and dependent children. (Required: Copy of marriage
certificate or proof of dependency.)
Full-time instructional and administrative personnel employed by state public schools and institutions of higher education and
their spouses and dependent children. (Required: Employment Verification)
Students from Latin America and the Caribbean who receive scholarships from the federal or state government. Any student
classified pursuant to this paragraph shall attend, on a full-time basis, a Florida institution or higher education. (Required:
proof of scholarship and Latin America or Caribbean residency.)
Southern Regional Education Board’s Academic Common Market graduate students attending Florida’s state universities.
(Required: Certification letter from State Academic Common Market Coordinator.)
Full-time employees of state agencies or political subdivisions of the state when the student fees are paid by the state agency
or political subdivision for the purpose of job-related law enforcement or corrections training. (Required: Employment
verification/payment agreement).
McKnight Doctoral Fellows and Finalists who are United States citizens. (Required: Verification from graduate studies.)
United States citizens living outside the United States who are teaching at a Department of Defense Dependent School or in
an American International School and who enroll in a graduate level education program which leads to a Florida teaching
certificate. (Required: Proof of enrollment in graduate program for FL teaching certificate.)
Active duty members of the Canadian military residing or stationed in this state under the North American Air Defense
(NORAD) agreement, and their spouses and dependent children, attending a Florida College System institution or state
university within 50 miles of the military establishment where they are stationed. (Required: Proof of active duty membership
for specified purpose.)
Active duty members of a foreign nation’s military who are serving as liaison officers and are residing or stationed in this state,
and their spouses and dependent children, attending a Florida College System institution or state university within 50 miles
of the military establishment where the foreign liaison officer is stationed. (Required: Proof of active duty membership for
specified purpose.)
TO BE COMPLETED BY THE CLAIMANT/PERSON CLAIMING FL RESIDENCY:
Note: If the student is a dependent, the parent is the claimant and will complete this section and provide evidence of residency
supporting the claim. If the student is independent, the student is the claimant and will complete this section and provide evidence
of residency supporting the claim. No signal document shall be conclusive in establishing residency. Additional
documentation, other than what is prescribed, may be requested in some cases. All documentation provided is subject
to verification. Evidence of ties to another state may result in denial of Florida residency for tuition purposes.
Claimant/Name of Person Claiming FL Res
idency:
Claimant’s Relationship to Student:
Claimant’s Address:
Telephone Number:
Date Claimant began establishing legal FL residence:
IF 036-WEIM rev. 6/27/18-daa page 3 of 4
PROVISION OF DOCUMENTS TO SUPPORT CLAIM OF FLORIDA RESIDENCY
Per s. 1009.21(3)(c), Florida Statutes, the residency determination must be documented by the submission of written or
electronic verification that includes two or more of the documents identified below. No single piece of evidence shall be
conclusive.
A. Claimant must provide at least one of the following of his/her personal documentation:
Florida Voter’s registration card Number: Issue Date: / /
Florida Driver’s license Number: Original Issue Date: / /
Current Issue Date: / /
Florida State identification card Number: Original Issue Date: / /
Current Issue Date: / /
Florida Vehicle registration Number: Original Issue Date: / /
Current Issue Date: / /
Proof of permanent home in Florida occupied as primary residence for 12 consecutive months prior to the student’s
enrollment. (Required: document such as a deed or other evidence of title to property used as primary residence, a
homeowner’s policy, a title insurance policy, evidence of a property tax payment on the primary residence, multiple
leases reflecting a Florida address, or a lease of multiple years’ duration.)
Proof of a homestead exemption in Florida. (Required: document from the county tax collector demonstrating the
application of a homestead exemption to the claimant’s primary residence.)
Official transcripts from a Florida high school for multiple years (2 or more years), if the Florida high school diploma or
GED
®
was earned within the last 12 months.
(Dates of Attendance: Graduation Date: / / ). (Transcript Required)
Proof of permanent full-time employment in Florida for at least 30 hours per week for a 12-month period.
(Required: pay stubs or W-2 form for past 12 consecutive months and/or verification from employers, and/or an IRS
1099 with verification of employment for the past 12 consecutive months from an employer.)
B. Claimant may provide one or more documents from the following categories to demonstrate residency in Florida (to
be used in conjunction with one document from above):
Declaration of domicile in Florida in accordance with s. 222.17. Florida Statutes.
Florida professional or occupational license.
Florida incorporation.
Document evidencing family ties in Florida
Proof of membership in Florida-based charitable or professional organization.
Any other documentation that supports your request for resident status, including, but not limited to, utility bills and proof
of 12 consecutive months of payments; a lease agreement and proof of 12 consecutive months of payments; or an official
state, federal, or court document evidencing legal ties in Florida.
RESIDENCY DECLARATION:
I, the undersigned, hereby declare that I have read the foregoing document and that the facts stated in it are true and further affirm
the authenticity of the information provided on all pages of this Residency Declaration. I understand that any false or misleading
information on this Residency Declaration, or provided in support of this Residency Declaration, will subject me to penalties
pursuant to section 837.06. Florida Statutes, for making a false statement. I give permission for the institution to review or examine
any and all documents and records, including those accessible electronically, which may assist in support of my claim as a Florida
resident for tuition purposes.
Student Name (Please Print):
Claimant Name (if not the Student):
Signature of Claimant (Electronic or ink): Date:
IF 036-WEIM rev. 6/27/18-daa page 4 of 4
The School Board of Broward County, Florida, prohibits any policy or procedure which results in discrimination on the basis of age, color, disability, gender identity, gender expression, genetic information, marital status, national origin, race, religion,
sex or sexual orientation. The School Board also provides equal access to the Boy Scouts and other designated youth groups. Individuals who wish to file a discrimination and/or harassment complaint may call the Director, Equal Educational
Opportunities/ADA Compliance Department & District’s Equity Coordinator/Title IX Coordinator at 754-321-2150 or Teletype Machine (TTY) 754-321-2158. Individuals with disabilities requesting accommodations under the Americans with Disabilities
Act Amendments Act of 2008, (ADAAA) may call Equal Educational Opportunities/ADA Compliance Department at 754-321-2150 or Teletype Machine (TTY) 754-321-2158.
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Career, Technical, Adult & Community Education

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Completed 8 January 2021

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