Denmark Technical College
Residency Information Form
Denmark Technical Col1ege is required under South Carolina Law 59-112 to determine residence classification of applicants and students for
purposes of receiving in-state tuition and fees. Substantiating documentation is required to affirm residence status. Additional information may
be requested if further clarification is needed.
Part A. Student Background Social Security # _______/ ________/ _______
Permanent address___________________________________________________________________________________
City______________________________State__________Zip__________ Telephone number( )__________________
_____________Length of time at this address Years__________ Months___________
List all addresses where you have lived for more than 30 days during the past 48 months. Begin with the most current address.
Address City/State Date
Part B. Residency Issues
1. Do you claim South Carolina as your residence for tuition purposes?______Yes________No
2. Upon whom are you basing your claim for residency? _____Self ____Parent _______Legal Guardian ______ Spouse
3. If claim for residency is based on you, answer the following:
a. How long have you resided in South Carolina? Years_____Months_____State of previous residency______________
b. If you moved to South Carolina within the past five years, what prompted your move to this state?
Education Employment other___________________________________________________________
c. Were you claimed as a tax dependent for the prior tax year before your admissions? Yes No
d. Previous state or country of residence: __________________________________________________________________
e. Your driver's license number_____________________State______________Date issued_________________________
This is a (check one) new license renewed license Expiration date____________________________
f. Have you been employed in South Carolina within the past 12 months?____Yes_____No (If yes, list employer's information)
Employer City/State Date Full or part-time Telephone Number
4. If your claim for residence status is based upon your parent, legal guardian or spouse, complete the following information.
a. Name of person upon whom residency is based__________________________________________________
b. Relationship to you: ______ parent
legal guardian spouse If spouse, date of marriage___________
c. How long has this person resided in South Carolina? Years____Months_____ State of previous residency_________
d. If this person moved to South Carolina within the past five years, what prompted their move to this state?
Education Employment other__________________________________________
e. Is this person a United States citizen? Yes No If no, country of citizenship__________________________
f. Has parent, legal guardian, or spouse claimed you as a dependent for federal tax purposes for the tax year preceding your term of
enrollment? Yes No
g. Driver's license number of parent, guardian or spouse___________________State_________Date issued___________
This is a (check one) new license renewed license. Expiration date____________________
h. Has your parent, guardian, or spouse been employed in South Carolina within the last 12 months?_____Yes_____No
If yes, list employer's information
Employer City/State Date Full or part-time Telephone number
5. If claim for in-state tuition is based upon current military assignment in South Carolina, complete the following information.
Documentation verifying military assignment must be submitted.
a. Person on active duty in service _____Self _____Spouse ____Parent/guardian Home State of record______________
b. Is the person in a reserve unit in South Carolina? _____ Yes _____No
I hereby certify that the information I have provided is accurate and that I am making this application in good faith based on the belief
that I am eligible to pay tuition and fees at a rate afforded to legal residents of South Carolina.
Print Full Name: ______________________________________________________
Revised May 2010
click to sign
click to edit
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome