Last Name___________________________First Name_________________________Birtdate_________________________UMES ID_______________
UNIVERSITY OF MARYLAND EASTERN SHORE Residency Information Form
Do you wish to be considered for in-state tuition status? Yes No (If yes, you must complete this section of the application.)
Do you wish to be considered for the discounted eastern shore of Virginia and Delaware rate? Yes No (If yes, complete 1-10)
IF ANY OF THE CATEGORIES BELOW APPLY, PLEASE CHECK THE APPROPRIATE BOX, PROVIDE REQUESTED INFORMATION AND/OR DOCUMENT.
I am a part-time (50%) or full-time regular employee of the University System of Maryland or, I am the spouse of, or am financially dependent upon a parent or legal
guardian who is, a regular employee of the University System of Maryland.
Please indicate relationship: ________________________________________________________________
Please attach a letter of verification from the Human Resources Office of the campus at which you or your spouse or parent or legal guardian is employed.
I am a full-time active member of the U.S. Armed Forces whose home of residency is Maryland or one who resides or is stationed in Maryland, or the spouse or a
financially dependent child of such a person. Please attach a copy of your deed or lease (if applicable), or verification from the service that you have declared Maryland as your
"home of residency" (if applicable); and the most recent assignment orders. Also, please indicate date of expected separation from the military _______________________________.
I am a veteran of the United States Armed Forces residing in Maryland. Please submit a copy of your DD214. If you have a discharge category other than honorable, please also
submit a copy of your Certificate of Eligibility.
I am the spouse or child of a veteran or active duty member of the United States Armed Forces using educational benefits under the Post-9/11 GI Bill (38 U.S.C. §3319) or
under 38 U.S.C.§ 3311(b)(9) and living in Maryland. Please submit a copy of the veteran’s DD214 and a copy of your Certificate of Eligibility.
I am eligible for in-state status considerations under the Maryland National Guard Nonresident Tuition Exemption. I am eligible because I (1) joined or subsequently served to
provide a critical military occupational skill or (2) am a member of the Air Force critical specialty code. I understand that I must provide documentation from my company commander
for consideration.
APPLICANTS SEEKING IN-STATE STATUS AS A MARYLAND RESIDENT MUST COMPLETE THE FOLLOWING QUESTIONS. Failure to complete all of the required items may result in a
non-Maryland resident classification and out-of-state charges being applied. Residency classification information is evaluated in accordance with the University System of Maryland policy
on residency. The applicant may be contacted for clarification of an item, or for additional information as necessary.
PLEASE CHECK ONE:
I am financially independent. I provide 50% or more of my own living and educational expenses and I have not been claimed as a dependent on another person's most recent income tax
returns.
I am financially dependent on another person who has claimed me as a dependent on his/her most recent income tax returns, or I am a ward of the State of Maryland. If a ward of the State,
please submit documentation and go to item 10.
Name of person upon whom dependent and relationship to applicant: _______________________________________________________________________________
a. How long have you been dependent upon this person? _____________________________________________________________________________________
b. Is the person a resident of Maryland? Yes No
Address of this person: ______________________________________________________________________________________________________________
c. Has this person claimed you as a dependent on their most recent tax returns? Yes No
d. Has this person filed a Maryland state income tax return for the most recent year on all earned taxable income? Yes No
If a Maryland tax return has not been filed within the last 12 months, state reason(s): _____________________________________________________________
e. Signature of this person: _______________________________________________________________________________________________________________
The Student Applicant is responsible for completing items 1 - 10.
1. Permanent address: ______________________________________________________________________________________________________________________
Length of time at permanent address _____ years _____ months
If less than 12 months, provide previous address: ________________________________________________________________________________________________
____________________________________________________________________________________________________________________
Length of time at previous address _____ years _____months
2. Did you move to Maryland primarily to attend an educational institution?
3. Are all, or substantially all of your possessions in Maryland?
4. Do you possess a valid driver's license?
a. If yes, in what state? __________________
b. If Maryland, initial date of issue ______________ and if applicable, renewal date ___________________
c. Have you possessed a driver’s license in a state other than Maryland within the last 12 months? Yes No
5. Do you own/lease any motor vehicles?
a. If yes, in what state(s)? _____________
b. If Maryland, initial date(s) of registration ___________________ and if applicable, renewal date(s) _____________
c. Did you register your vehicle(s) in a state other than Maryland within the last 12 months? Yes No
6. Are you registered to vote?
If yes, in what state? ___________________________
7. Have you filed a Maryland state income tax return for the most recent year?
If a Maryland tax return has not been filed within the last 12 months, state reason(s):
______________________________________________________________________________________________________
8. Is Maryland state income tax currently being withheld from your pay? If no, provide explanation.
______________________________________________________________________________________________________
9. Do you receive any public assistance from a state or local agency other than one in Maryland?
If yes, indicate type and issuing state: ___________________________________________________________________________________
10. I certify that the information provided is complete and correct. I understand that the University reserves the right to request additional information if necessary. In the event the University discovers that false or
misleading information has been provided, the Student Applicant may be billed by the University retroactively to recover the difference between in-state and out-of-state tuition for the current and subsequent semesters.
__________________________________________________________________________________ ______________________________________
Signature of Applicant Date
