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.
Signature______________________________________Date______________________________________
Print Full Name: ______________________________________________________
Revised May 2010
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