Fillable Core-Residency-Questionnaire TWU Core Residency Questionnaire

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Core-Residency-Questionnaire TWU Core Residency Questionnaire

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Texas Woman’s University
REVISED CHART II
Core Residency Questionnaire
For Office Use Only
Doc Type: __RQ__
Description:
Texas higher Education Coordinating Board rule 21.731 requires each student applying to enroll at an institution to
respond to a set of core residency questions for the purpose of determining the student’s eligibility for classification as a
resident.
State
SECTION A. (All students must complete this section.)
NAME: ____________________________________________________________ ID# ___________________________
Date of Birth: __________________________________ Phone #: ____________________________________________
Address: _
Street
_____________________________
City
___________________________________________________________ _
Zip County
Previous Address: ___________________________________________________________________________________
Street City State Zip County
Term for which you are applying for the resident rate: Year: _______________ Term: _________________
*The questionnaire and all supporting documentation must be received in the Registrar’s Office prior to the census date of the requested term.
Please see Revised Chart II, Documentation to Support Establishing and Maintaining Domicile in Texas for a reference of acceptable supporting
documentation. http://www.twu.edu/downloads/registrar/establishingdomicile.pdf
SECTION B. Previous Enrollment (for all students)
1. During the 12 months prior to the term for which you are applying, did you attend a public college or university
in Texas in a fall or spring term? ______ Yes ______ No
o If you answered no, continue to section C. If you answered yes, complete questions 2 through 5.
2. What Texas public institution did you last attend? (Full name and city are required. Do not enter university
initials.)
___________________________________________________________________________________
3. In which terms were you last enrolled? (Check all that apply.)
_____ Fall 20____ _____Spring 20_____
4. During your last semester at a Texas public institution, did you pay the resident (in-state) or non-resident (out of
state) tuition rate?
_____ Resident (in-state) _____ Nonresident (out-of-state) _____ Unknown
5. During your last semester at a Texas public institution, was it because you were classified as a Texas resident for
tuition purposes or because you were a nonresident who received a waiver?
_____ Resident (in-state) _____ Nonresident with a waiver _____ Unknown
IMPORTANT: If you were enrolled at a Texas public institution during a fall or spring semester within the previous 12
months and were classified as a Texas resident, skip to section H, sign and date this form and submit it to your
institution. If you were not enrolled, or if you were enrolled but classified as a nonresident, proceed to Section C.
SECTION C. Residency Claim.
1. Are you a resident of Texas? _____ Yes _____ No
If yes, continue to part D.
If no, complete the following questions and continue to section H.
_____
_____
_____
2. Of what state or country are you a resident? ______________________________________________________
If you are uncertain, continue to section D.
SECTION D. Acquisition of High School Diploma or GED.
1. Did you graduate, or will you graduate, from a Texas high school, or complete a GED in Texas, prior to the term
for which you are applying? _____ Yes _____ No
a. If you graduated from high school, what was the name, city and state of the school?
__________________________________________________________________________________________
Name of High School City State
2. Did you live in Texas the 36 months leading up to high school graduation or completion of the GED?
_____Yes _____No
3. When you begin the semester for which are applying, will you have lived in Texas for the previous 12 months?
_____ Yes _____ No
4. Are you a U.S. Citizen or Permanent Resident of the United States of America?
_____ Yes _____ No
Instructions to Section D:
• If you answered “No” to question 1a or 2 or 3, continue to Section E.
• If you answered “Yes” to all four questions, skip to Section I.
If you answered “Yes” to questions 1, 2 and 3, but “No” to question 4, complete a copy of the Affidavit, skip to part I of
this form, and submit both this form and the affidavit to your institution.
SECTION E. Basis of claim to residency. (To be completed by everyone who did not answer YES to questions 1, 1a, 2
and 3 of section D.
1. Do you file your own federal income tax as an independent tax payer? _____ Yes _____ No
2. Are you claimed as a dependent or are you eligible to be claimed as a dependent by a parent or court-appointed
legal guardian? _____ Yes _____ No
(To be eligible to be claimed as a dependent, your parent or legal guardian must provide at least one half of your
support. A stepparent does not qualify as a parent if he/she has not adopted the student.)
3. If you answered no to both questions above, who provides the majority of your support?
_____ Self _____ Parent or Guardian _____ Other:
(list)____________________________________
Instructions for Section E:
• If you answered “Yes” to question 1, continue to Section F.
• If you answered “Yes” to question 2, skip to Section G.
• If you answered “No” to 1 and 2 and “self” to question 3, continue to Section F.
• If you answered “No” to 1 and 2 and “parent or guardian” to question 3, skip to Section G.
• If you answered “No” to 1 and 2 and “other” to question 3, skip to Section H and provide an explanation, and
complete Section I.
SECTION F. If you answered “Yes” to question 1 or “Self” to question 3 of Section E, answer the following:
*If you answer yes to any section of questions 8 or 9, you will need to provide proof (proof of home/business ownership, professional license, letter
from employer, pay stubs, etc.)
**If you answer yes to question 10 and have been married at least 12 months, then you will need to provide a copy of your marriage certificate
with proof of what your spouse can answer yes (proof of home/business ownership, professional license, letter from employer, pay stubs, etc.)
1. Are you a U.S. Citizen?
_____ Yes _____ No
2. Are you a Permanent Resident of the United States of America?
_____ Yes _____ No
3. Are you a foreign national whose application for Permanent Resident Status
has been preliminarily reviewed? (You should have received a fee/filing
receipt or Notice of Action (I-797) from USCIS showing your I-485 has been
reviewed and has not been rejected.)
_____ Yes _____ No
4. Are you a foreign national here with a visa or are you a Refugee, Asylee,
Parolee or here under Temporary Protective Status?
_____ Yes _____ No
Visa / Status: ________________
5. Do you currently live in Texas?
_____ Yes _____ No
6. If you currently live in Texas, how long have you been living here?
_____ Months _____ Years
7. What is your main purpose for being in the state?
If for reasons other than those listed to the right, give an explanation in
section I.
_____ Go to College
_____ Establish / Maintain Home
_____ Work Assignment
8. If you are a member of the U.S. military, is Texas your Home of Record?
_____ Yes _____ No
a. What state is listed as your military legal residence for tax
purposes on your Leave and Earnings Statement?
State:
9. Do any of the following apply to you?
a. Do you hold the title to real property (home, land) in Texas?
_____ Yes _____ No
i. If yes, what was the date acquired?
Date:
b. Do you own a business in Texas?
_____ Yes _____ No
ii. If yes, what was the date acquired?
Date:
c. Do you hold a state or local license to conduct a business or practice a
profession in Texas?
_____ Yes _____ No
iii. If yes, what was the date acquired?
Date:
10. While living in Texas have you:
a. Been gainfully employed for at least 12 consecutive months?
*Gainful employment requires an average employment of at least 20 hours per week for one year
or earnings equal to at least half of tuition and living expenses for one 9 month academic year.
Student employment does not constitute gainful employment.
_____ Yes _____ No
b. Received services from a social service agency that provides services to
homeless persons?
_____ Yes _____ No
11. Are you married to a person who could answer yes to any part of questions
9 or 10?
_____ Yes _____ No
a. If yes, indicate which question(s) could be answered yes by your spouse.
9 10
b. How long have you been married to a Texas Resident?
_____ Months _____ Years
SECTION G: If you answered “Parent” or “Legal Guardian” to question 3 of section E answer the following:
*If you are basing your residency on a parent/legal guardian, you will need to submit a copy of the court paperwork showing guardianship or proof
that you are claimed as a dependent. (
**If you answer yes to any section of questions 8, 9, or 10 for your parent/guardian, you will need to provide proof (proof of home/business
ownership, professional license, letter from employer, pay stubs, etc.)
1. Is the parent or legal guardian upon whom you base your claim of residency
a U.S. Citizen?
_____ Yes _____ No
2. Is the parent or legal guardian a Permanent Resident of the United States of
America?
_____ Yes _____ No
3. Is this parent or legal guardian a foreign national whose application for
Permanent Resident Status has been preliminarily reviewed? (Your parent
or legal guardian should have received a fee / filing receipt or Notice of
Action (I-797) from U.S. Citizenship and Immigration Services (USCIS)
showing the I-485 has been reviewed and has not been rejected.)
_____ Yes _____ No
4. Is this parent or legal guardian a foreign national here with a visa or are you
a Refugee, Asylee, Parolee or here under Temporary Protective Status? If
so, indicate which: *If so, attach copy.
Visa/Status:
5. Does this parent or legal guardian currently live in Texas? If he or she is out
of state due to a temporary assignment by his / her employer or other
temporary purpose, please explain in Section H.
_____ Yes _____ No
_____
_____
_____
______
_____
6. If he or she is currently living in Texas, how long has he or she been living
here?
_____ Months _____ Years
a. What is your parent’s or legal guardian’s main purpose for being in
the state?
If for reasons other than those listed above, give an explanation in
Section H.
_____ Go to College
_____ Establish / Maintain Home
_____ Work Assignment
7. If he or she is a member of the U.S. military, is Texas his or her Home of
Record?
_____ Yes _____ No
a. What state is listed as his or her military legal residence for tax
purposes on his or her Leave and Earnings Statement?
State:
8. Do any of the following apply to your parent or guardian:
a. Hold the title to real property (home, land) in Texas?
_____ Yes _____ No
ii. If yes, date acquired:
Date:
b. Own a business in Texas?
_____ Yes _____ No
ii. If yes, date acquired:
Date:
9. While living in Texas, has your parent or guardian:
a. Been gainfully employed for a period of at least 12 consecutive
months?
*
Gainful employment requires an average employment of at least 20 hours per week for
one year or earnings equal to at least half of tuition and living expenses for one 9 month
academic year. Student employment does not constitute gainful employment.
_____ Yes _____ No
b. Received services from a social service agency for a period of at
least 12 consecutive months?
_____ Yes _____ No
10. Is your parent or legal guardian married to a person who has been classified
as a Texas resident by a Texas public institution or who could answer “yes”
to any part of question 8 or 9?
_____ Yes _____ No
a. If yes, indicate which question (and which part of the question)
could be answered yes by your parent or guardian’s spouse.
Question:
b. How long will your parent or guardian have been married to the
Texas resident prior to enrollment? *If so, attach documentation.
_____ Months _____ Years
SECTION H: General Comments: Is there any additional information that you believe your college /university should
know in evaluating your eligibility to be classified as a resident? If so, please provide it below:
SECTION I: Certification of Residency. All students must complete this section.
I understand that officials of my college/university will use the information submitted on this form to determine my
status for residency eligibility. I authorize the college/university to verify the information I have provided. I agree to
notify the proper officials of the institution of any changes in the information provided. I certify that the information on
this application is complete and correct and I understand that the submission of false information is grounds for
rejection of my application, withdrawal of any offer of acceptance, cancellation of enrollment and/or appropriate
disciplinary action.
Signature: Date:
_____
_____
_____
_____
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Core-Residency-Questionnaire TWU Core Residency Questionnaire

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Completed 6 November 2019

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