Fill - Free fillable DOMICILE AFFIDAVIT PERSONAL INFORMATION registration@cochise.edu Admissions and Registration (Cochise College) PDF form

Admissions and Registration

FOR OFFICE USE

Collected by: _______________ Date:__________________

 Approved  Denied Term: ____________________

 PROP 300 Date: ____________________________

Registrar Signature:________________________________

Approved by the state board on 8/19/89 in compliance with r7-1-23

STATE BOARD OF DIRECTORS FOR COMMUNITY COLLEGES OF ARIZONA

A one-year residency requirement is enforced in order for a student to be classified as an in-state student for tuition purposes. The responsibility of registration under the

proper residence classification is placed upon the student. Any student who is found to be classified improperly shall be required to pay full tuition, or be subject to dismissal

from the college. In doubtful cases, a certified statement or documentation of the facts me be required. (Please print or type. Additional information may be submitted.)

SEE INSTRUCTIONS ON REVERSE SIDE.

PERSONAL INFORMATION

Student ID #: Date of Birth:

Last Name: First: M.I.:

Street Address:

City: State: AZ ZIP:

Phone: Citizenship Status: United States Other ______________________

Current driver’s license or state ID number:______________________ State Issued: _____ Date issued: __________

Renewal? No Yes If yes, what is the original date issued?

RESIDENCY INFORMATION

When did your current residency in Arizona begin?

Are you registered to vote in Arizona? No Yes County?

Military/Veteran Status: Non-Military Active Duty Military Dependent Veteran ETS Date________________

Reservist National Guard Arizona Unit Address?

Are you a member of Homeland Security stationed in Arizona? No Yes

Are you a full-time employee of an Arizona school district as a teacher or teacher’s aide? No Yes

Are you a resident member of an Indian tribe whose reservation land lies in this state and/or extends into another

state? No Yes If yes, which reservation?

Did your employer require that you, your spouse, or parent(s) be transferred to Arizona? No Yes

If yes, what is the name of the employer?

Will you file taxes in Arizona this year? No Yes Did you file taxes in Arizona last year? No Yes

Have you attended another college or university within the past year outside of Arizona? No Yes

If yes, did you pay resident tuition? No Yes

I certify that the information provided is correct.

Signature Date

901 N Colombo Ave

Sierra Vista, AZ 85635-2317

Phone: 800-593-9567

registration@cochise.edu

DOMICILE AFFIDAVIT

DOMICILE AFFIDAVIT INSTRUCTIONS:

 Read all instructions carefully.

 Type or print legibly in blue or black ink.

 COMPLETE all applicable information then SIGN and DATE the document

Arizona Residency Information:

Residency policies are the same for all Arizona community colleges. In order to be considered an

Arizona resident for college tuition purposes, you must:

 Live in Arizona for one full calendar year, or

 Active Duty Military/Dependent, Reservist or National Guard member stationed in Arizona, or

 Member/Dependent or homeland Security stationed in Arizona, or

 Transferred to Arizona by a company or organization, or

 A legal dependent of a parent who is a legal resident of Arizona, or

 A full-time employee of an Arizona school district as a teacher or teacher’s aide, or

 A member of an American Indian tribe whose reservation lies wholly, or in part, in Arizona, or

 An honorably discharged veteran who is registered to vote in Arizona

For more information, go to the Cochise College Catalog under Residency Requirements and

Regulations and the State Board website at: http://www.azleg.gov/ars/15/01802.htm.

You must initiate change in your residency status from out-of-state. Cochise College will not

automatically adjust your status. When you believe you have met the qualifications for Arizona

residency, complete the Domicile Affidavit form, attach copies of three (3) supporting documents, at

least one document must be one year old before the last day to add of the upcoming semester, and

submit all information to the Registrar at Cochise College. Valid supporting documents include:

 Filing of Arizona state income tax report for the previous year.

 Current registration of motor vehicle in Arizona.

 Current voter registration in Arizona.

 Arizona driver’s license issuance date.

 Recent graduation from an Arizona high school.

 Bank statement (checking or savings) from an Arizona banking institution.

 Source of support (wage earning statement).

 Dependency as indicated on federal income tax declaration for dependents.

 Utility receipt, Property Ownership Document or Rental Agreement.

Revised 8/14

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