April 4, 2013
Colorado Residency Application
Students who may be classified as Colorado state residents are encouraged to complete this form. The University of Denver receives some
state funds based on students’ residency. Please answer the following questions carefully. Type information directly onto this form, sign and
date it, and return the completed form to the Office of the Registrar, University Hall, Room G55, 2197 South University Blvd., Denver, CO
80208. The form may be faxed to 303.871.4300 . You may also save information in the form and email it to registrar@du.edu. Your typed
name will constitute a signature for emailed forms. . Incomplete forms will not be processed.
Section I – Student Personal Information
Name:
DU ID #:
Date of Birth:
Ag
e:
Did
y
ou
g
raduate from a Colorado Hi
g
h School?
If
y
es, date of
g
raduation:
Name of Colorado Hi
g
h School:
Dates attended Hi
g
h School
(
months/
y
ear
)
From
To
A
re
y
ou a U.S. Citizen:
Com
lete the followin
if
ou are not a U.S. Citizen
Countr
y
of Citizenship: Do
y
ou have a U.S. Visa?
Visa T
y
pe: Visa Number:
Expiration Date:
Section II – Residency Information
If
y
ou are a
g
e
22
or older, com
p
lete the section for YOU. If
y
ou are under the a
g
e of
2
2
, com
p
lete section for PARENT or
PARENT or GUARDIAN
Y
OU
Dates of continuous physical presence
in Colorado (mo/yr):
From To From To
Dates of extended absences from
Colorado during the last two years:
From To From To
Driver’s License Information:
State
License #
State License #
Is this a new license or renewal? New
Renewal
New
Renewal
Motor Vehicle Registration (for past 12
months):
State License Plate State License Plate
Physical Address (for past 12 months)
Dates at that address:
From
To
From To
Previous Address (within last 12
months)
Dates at that address
From
To
From To
Em
p
lo
y
er within
p
ast two
y
ears
Dates of Em
p
lo
y
ment
From
To
From To
Previous Em
p
lo
y
er
(
within last two
Dates of Em
p
lo
y
ment
From
To
From To
List the states where you filed state
taxes for the past two years:
State: Year Filed:
State: Year Filed:
State: Year Filed:
State: Year Filed:
Section III
Signature
I hereby certify that, to the best of my knowledge, the information furnished in this application is true and complete without intent of evasion
or misrepresentation. I understand the above information is submitted under penalty of perjury and false or misrepresented data is
sufficient cause for dismissal.
Parent or Guardian Si
g
nature
Student Si
g
nature
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