Fillable District Office of Veterans Affairs Statement of Intent (Houston Community College)

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District Office of Veterans Affairs Statement of Intent (Houston Community College)

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The District Office of Veterans Affairs Statement of Intent (Houston Community College) form is 2 pages long and contains:

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  • 0 check-boxes
  • 42 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Houston Community College

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District Office of Veterans Affairs
Statement of Intent
My name is __________________________________________________________
(Last) (First) (Student ID #)
and I intend to change my resident from ___________ to the State of Texas.
Signature of Student
Signature of Registrar/Admission Representative Date
c: student’s file
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signature
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signature
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I
DATA
ENTERED
HOUSTON
COMMUNITY
COLLEGE
SYSTEM
CHANGE OF RESIDENCY PETITION
......-.
-------J
IN ORDER TO GUARANTEE THAT A RESIDENCY CHANGE WILL BE MADE PRIOR TO THE PAYMENT OF
FEES,
THIS RESIDENCY PETITION AND
ALL SUPPORTING DOCUMENTS MUST BE PRESENTED TO THE APPROPRIATE CAMPUS OFFICIAL BEFORE
REGISTRATION.
PETITIONS
SUBMITTED AFTER REGISTRATION WILL BE EFFECTIVE FOR THE FOLLOWING TERM.
SOCIAL SECURITY NO./STUDENT I.D.NO. EMP. I.D.
NO.
NAME
LAST FIRST
M.L
I
HOME ADDRESS
STREET APT. NO. CITY COUNTY STATE
ZIP
[TI
COMPLETE
THIS SECTION IF YOU ARE PETITIONING FOR CHANGE FROM NON RESIDENT TO RESIDENT STATUS
BASIS FOR CHANGE (CHECK ONE)
0
VISA CHANGE NEW VISA TYPE
_
0
MET 12 MONTH RESIDENCY REQUIREMENT. (MUST BE CITIZEN, PERMANENT RESIDENT, OR HAVE
ELIGIBLE VISA CLASSIFICATION ACCORDING TO TEXAS EDUCATION CODE (54.052)
OOTHE
R
NOTE: ATTACH COPIES OF ALL
SUPPORTING DOCUMENTS
COMMENTS
OFFICE USE ONLY
RES
.
--------
COUNTY
_
VISA
[]]
COMPLETE THIS SECTION IF YOU ARE PETITIONING FOR CHANGE FROM OUT-QF -DISTRICT TO IN-DISTRICT RESIDENCY STATUS
IN
WHAT
SCHOOL DISTRICT DO YOU RESIDE?
0
HISD
0
STAFFORD
0
ALIEF
0
KATY
0
SPRING
0
CY-FAIR
0
SPRING BRANCH
0
FORT BEND
0
NORTH FOREST
0
PASADENA
0
GALENA PARK
0
PEARLAND
0
CHANNELVIEW
0
ALDINE
OOTHE
R
INITIAL DATE OF RESIDENCY IN DISTRICT
_
OFFICE USE ONLY
RES.
_
COUNTY
_
THIS PETITION IS NOT VALID UNLESS SIGNED AND DATED AND ALL SUPPORTING DOCUMENTS ARE ATTACHED.
I UNDERSTAND THAT THE PURPOSE OF THIS PETITION IS TO SUBMIT INFORMATION FOR DETERMINATION OF
RESIDENCY FOR TUITION
PURPOSES AT
HOUSTON COMMUNITY COLLEGE SYSTEM. FALSE INFORMATION IS GROUNDS FOR RETROACTIVE PAYMENT
OF NON-RESI-
DENT FEES OR WITHDRAWAL FROM THE COLLEGE AND LOSS OF CREDIT.
VERIFIED
BY
OAT
\
STUDENT SIGNATURE DATE
CAMPUS
W1rh fe -v
exceorions, state
fa>'•'
gives _vou
ihe ngflt to
requesr. receive. revteVI
and correct mtormarion about yourself collected
on
thts
form
FORM 200
(rev.11/02)
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District Office of Veterans Affairs Statement of Intent (Houston Community College)

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Completed 6 October 2020

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