Fill - Free fillable FILLABLE CCSU Applicationfor In State Tuition6 25 15 (Central Connecticut State University) PDF form

CENTRAL CONNECTICUT STATE UNIVERSITY

Updated 6/25/15

APPLICATION FOR IN-STATE TUITION

1

In-state tuition rates are a privilege authorized by the Connecticut General Statutes and are

awarded only upon successful application for in-state tuition. Generally, the residency

classification is determined at the time of application for admission.

The University makes its decisions according to the applicable state law and within procedures

developed to conform to the boundaries of this law. In-state tuition is governed by General

Statutes 10a-26, et. seq. Additionally, the Veterans Access, Choice, and Accountability Act of

2014 (HR 3230) requires CCSU to charge qualified veterans, and their dependents, in-state

tuition. The purpose of this application packet is to help you collect and submit the appropriate

documentation to support your petition for in-state tuition rates.

An individual is eligible for in-state tuition under one of the following conditions: (1) as an

emancipated student who is domiciled in Connecticut; (2) as an unemancipated student whose

parents are domiciled in Connecticut; (3) as a Connecticut resident who attended two years of

and graduated from a Connecticut high-school; (4) as an emancipated student whose spouse is

domiciled in Connecticut; (5) as a member of the military whose Home of Record is Connecticut

or who is stationed in this state pursuant to military orders; OR (6) as a veteran, or the

dependent of a veteran, who resides in Connecticut and was discharged no more than three

years prior to enrollment, after a period of at least 90 days, who is using VA education benefits

under the Montgomery GI Bill – Active Duty (Chapter 30) , Post 9/11 GI Bill (Chapter 33), or

Marine Gunnery Sergeant John David Fry Scholarship.

There are three steps by which you apply for in-state tuition. First, you must determine the

criteria you are using to support your application. Second, you need to collect and submit the

appropriate documentation by the due date. Finally, we ask you to sign a notarized affidavit

confirming the accuracy of the information submitted. Please note you may or may not be

called for an interview, after which you will receive notification of your application status. A

completed Application for In-State Tuition must be received prior to the start of the semester

that a student is claiming eligibility.

A Note on the Importance of Accuracy and Honesty:

All students are subject to Connecticut State University Student Code of Conduct & Statement

of Disciplinary Procedures, which prohibits the act of providing false information to school

officials. Students who falsify their information or intentionally submit inaccurate information

will be subject to the Student Code of Conduct. For more information, please see

http://www.ccsu.edu/uploaded/departments/student_affairs/pdfs/2011_student_code_of_co

nduct.pdf.

1

CCSU Gratefully acknowledges the University Of Connecticut since it developed this form and granted CCSU

permission to use it.

2

STEP ONE: DETERMINE YOUR APPLICATION CLASSIFICATION (Please check one.)

You can apply for in-state tuition based on one of five criteria, as follows. Once you determine

the appropriate criterion, use the information in this application to guide your process. Please

note that all documentation is required, unless otherwise noted.

____ You are applying as an emancipated student using your own information.

In order to be an emancipated student, you must be at least 18 years old and you cannot

receive regular financial assistance from parents or guardians. In step 2, you will have to

submit documents to demonstrate that you are financially independent and that you are

domiciled in Connecticut.

____ You are applying as an unemancipated student using your parental or guardian

information.

In order to be eligible as an unemancipated student using parental/guardian

information, your parents/guardian have to have resided in Connecticut for at least six

consecutive months and be employed full-time. In step 2, your parents/guardians will

have to submit financial statements and other documents to demonstrate they are

domiciled in Connecticut.

____ You are applying as a Connecticut resident who attended two years of and graduated

from a Connecticut high-school.

In order to be eligible, you must be a Connecticut resident, have attended two years of a

Connecticut high school, graduated from a Connecticut high school and be registered as

an entering student at or enrolled in the University.

____ You are applying as an emancipated student using your spouse’s information.

In order to be eligible to receive in-state tuition through your spouse, your spouse has to

have resided in Connecticut for at least six consecutive months and be employed full-

time. In step 2, your spouse will have to submit financial statements, other documents to

demonstrate s/he is domiciled in Connecticut and a marriage certificate.

____ You are a member of the military (1) whose Home of Record is Connecticut; or (2) who

is stationed in this state pursuant to military orders.

In order to be eligible as a member of the military, you have to be stationed in the State

of Connecticut pursuant to military orders. In step 2, you will have to submit a copy of

your military orders showing your Connecticut station.

____ You are a veteran, or the dependent of a veteran, who resides in Connecticut and was

discharged no more than three years prior to enrollment, after a period of at least 90

days, who is using VA education benefits under the Montgomery GI Bill – Active Duty

(Chapter 30) , Post 9/11 GI Bill (Chapter 33), or Marine Gunnery Sergeant John David Fry

Scholarship.

In order to be eligible to receive in-state tuition you must contact the CCSU Veteran’s

Affairs Office at (860) 832-2838 or VetAffairs@ccsu.edu. Do not complete this

application packet. The Veteran’s Affairs Office will assist with verifying your eligibility

for in-state tuition.

3

First Last Middle

Number & Street City State Zip

STEP TWO: APPLICANT INFORMATION

This must be completed by all student applicants.

Name (print) ________________________________________ Phone (____) ______________

Under which classification are you filing? (See Step One)________________________________

Current Residential Address _______________________________________________________

Email _________________________________________________________________________

Student Identification Number ______________ Age _____ Date of Birth ______________

1. For what term are you seeking in-state tuition classification?

Fall Spring Summer Year_____________

2. Have you previously applied at this institution for a change in residence status?

Yes No If “yes,” indicate term ____________ and year ____________

3. What high school(s) did you attend and graduate from (or the equivalent?)

School ______________________________ Years attended __________

Town ______________________________ State __________

If necessary, Additional school ___________________ Years attended __________

Town ________________________________ State __________

High school from which you graduated: _______________________________

4. If applicable, what other degrees have you obtained, from where?

School ______________________________ Grad Year __________

5. When did your most recent continuous stay in Connecticut begin?

Month ________________ Day _______________ Year __________

4

(Include room/board, tuition and other general support)

(Include wages, salary, commission, interest income, etc.)

(Include spouse, financial aid, gifts, personal loans, savings, financial

support from relatives or friends, inheritance, trusts, stocks, bonds, VA

benefits, etc.)

a. $

b. $

c. $

Total of a, b, c: $

$

Total Expenses

The total of a, b, and c should meet or exceed the Total Expenses

6. Since your most recent continuous stay in Connecticut began, have you attended

another Connecticut college or university (including community college)?

Yes No

7. Have you attended a Connecticut high school under “A Better Chance” program or

another high school program established for the purpose of giving minority students the

opportunity to attend school? (See C.G.S. 10a-29(8) for description)

Yes No If “yes,” give program and dates ____________________________________

8. Are you a citizen of the USA? Yes No. If “no,” please attach a copy of both

sides of your Resident Alien Card, Change of Status Application, or other

documentation reflecting your visa type or current status, if available.

9. List totals of your financial resources for the past 12 months:

a. Support from parent, legal custodian, or other person

b. Self support

c. Other support from outside sources

5

Last First Middle

Number & Street State City Zip

You must attach proof of your presence in Connecticut for the past 12 months (e.g. copies of

rent receipts, lease or home purchase agreements, cancelled rent checks, notarized letter from landlord.)

Dates

Location Employer or Activities

mo/day/yr

City

State

Employer/Activity

Hours/week

STEP THREE: PROOF OF DOMICILE

This is to be filled out by the individual whose domicile this application is based on. Do not leave any

questions blank. No action or decision can be made unless all questions are completed and all required

documentary evidence is submitted.

The individual completing this Section must complete the affidavit in Step Four.

This section is being completed and signed by Student Parent Legal Custodian Spouse

1. Name (print) ___________________________________ Phone (____) ______________

Address _______________________________________________________________

2. Date of arrival in Connecticut to establish a permanent home: Mo. ___ Day ___ Yr. ____

[If applying as spouse]: Why you moved to Connecticut: ________________________

_______________________________________________________________________

3. Are you a citizen of the USA? Yes No. If “no,” you must attach a copy of both

sides of Resident Alien Card, Change of Status Application, or other documentation

reflecting your visa type or current status. Students completing this section may skip

the question.

4. Do you own rent your housing? If not, explain how your housing is provided:

________________________________________________________________________

5. List chronologically your employment or physical presence for the past two years, giving

exact information as asked below. Add more pages if needed.

from _______ to _______ ____________________ ________________________________

6

mo/day/yr

City

State

Reason

6 If you were out of Connecticut during the past 12 months, give dates and reasons for

your absence.

from _______ to _______ ____________________ ________________________________

6. Are you registered to vote? Yes No If “yes,” where/when:

Attach copy of your current voter’s registration card.

7. Do you own or use any motor vehicles? Yes No If “yes,” give type of vehicle,

license number, state, and dates of registry. You must attach a copy of vehicle

registration (not title).

________________________________________________________________________

8. Do you have a driver’s license? Yes No If “yes,” you must attach a copy of your

driver’s license.

9. Do you have a checking account? Yes No If “yes,” since what date? ___________

Financial Institution ______________________ City ________________ State ________

Do you have a savings account? Yes No If “yes,” since what date? _____________

Financial Institution _____________________ City ________________ State ________

7

(Note: See the “Financially Independent” section on the instruction page for documentation of tax

10. Did you file a Connecticut Income Tax Return from a Connecticut address in the previous

filing year? _______________________

If “no,” please explain:

________________________________________________________________________

11. Do you intend to file a Connecticut Income Tax Return this year? Yes No

If “no,” why not?__________________________________________________________

12. Is income being withheld from your earnings for Connecticut income taxes? Yes No

Please attach a copy of your federal and state tax returns.

Please complete the Affidavit in Step Four on the next page.

Please attach all information/documents that you wish to include to support your

case as outlined on pages 10 and 11 of this affidavit form.

FOR OFFICE USE ONLY:

__________________________________________________________________

Application status: Approved Denied, for reasons identified below:

8

STEP FOUR: AFFIDAVIT

TO BE COMPLETED BY THE INDIVIDUAL WHO COMPLETED STEP THREE.

PLEASE DO NOT FILL OUT THE REMAINDER OF THIS AFFIDAVIT UNTIL

YOU ARE IN THE PRESENCE OF A NOTARY PUBLIC

STATE OF _________________________ COUNTY OF __________________________________

Under penalty of perjury under the laws of the State of Connecticut, I swear or affirm that all

of the information and supportive documentation supplied by me in this affidavit is complete,

true and correct, and that Central Connecticut State University may rely on this information. I

hereby declare that if I am an alien without lawful immigration status, I have filed an

application to legalize my immigration status or will file an application as soon as I am eligible

to do so. I further understand that if any of the above information is untrue, the applicant will

be liable for the payment of all nonresident charges from which he or she was exempted and

may be subject to disciplinary action by Central Connecticut State University.

_________________________________________________________

Signature of individual in the presence of Notary Public

_________________________________________________________

Full Mailing Address

_____________________ _______________________________

Phone Number Email Address

SUBSCRIBED and SWORN before me this ________ day of ________, 2_______

(Seal)

____________________________________________

Notary Public

My commission expires: ________________________

__________________________________________________________________________

9

PLEASE SUBMIT THIS FORM AS DIRECTED BELOW:

Prospective undergraduate students:

Office of Admissions

1615 Stanley Street

Lawrence Davidson Hall, Room 115

New Britain, CT 06050

Phone: (860) 832-2278

admissions@ccsu.edu

Currently enrolled undergraduate and

graduate students appealing a previous

residency determination

Office of the Registrar

1615 Stanley Street

Lawrence Davidson Hall, Room 116

New Britain, CT 06050

Prospective graduate students:

Graduate Recruitment & Admissions

1615 Stanley Street

Barnard Hall, Room 102

New Britain, CT 06050

Phone: (860) 832-2350

Fax: (860) 832-2362

Phone: (860) 832-2236

Fax: (860) 832-2250

10

PLEASE COMPLETE CHECKLIST PRIOR TO SUBMISSION

1. You are applying as an emancipated student using own information:

Mandatory Documents:

□ Connecticut license OR Connecticut state ID.

□ If applying at the time of admission, documents that demonstrate student has resided in

the state at least 365 days prior to the first day of classes.

□ Last W-2’s and tax filing showing that no one claimed you as a dependent on their taxes

in the last tax year or a Statement of Non-filing. (Please redact social security numbers.)

□ Front Page of Student’s federal and Connecticut state tax return.

(Please redact social security numbers.)

□ Financial Aid letter or description of financial aid support.

□ Room and board: [Housing bills, rent, mortgage, lease, cancelled checks showing you’ve

paid mortgage/rent or notarized letter from landlord.]

□ Utility bills: [May include but may not be limited to heat, hot water, cable, internet.]

(Please submit bills and cancelled checks.)

If student drives a car, must submit:

□ Car registration (filed in your name).

□ Proof of Connecticut car insurance.

Other Documents:

□ Proof of Voter Registration.

□ Others:__________________________________________________________________

________________________________________________________________________

2. You are applying as an unemancipated student and you are using your parental/guardian

information:

Mandatory Documents:

□ Parent’s/Guardian’s Connecticut license OR Connecticut state ID.

□ Parent’s/Guardian’s last W-2’s and tax filing.

□ Documents that demonstrate your parent(s)/guardian(s) have resided in the state at

least six consecutive months prior to the date of application for in-state tuition (the date

you submit this document).

□ Any other documents requested by the University that demonstrate a continuous and

permanent physical presence in Connecticut, including but not limited to motor vehicle

registration, motor vehicle insurance, etc.

Other Documents:

11

□ Proof of Voter Registration.

□ Others:__________________________________________________________________

________________________________________________________________________

3. You are applying as a Connecticut resident who attended/graduated from a Connecticut

high school:

Mandatory Documents:

□ Connecticut driver’s license OR Connecticut state ID, if available.

□ Documents that demonstrate student resides in the state of Connecticut, including but

not limited to tax returns, identification cards, car registration, utility bills and other

mail, etc.

□ Copy of all high school transcripts.

□ Copy of high school diploma or transcript with graduation date.

4. You are applying as an emancipated student using your spouse’s information:

Mandatory Documents:

□ Spouse’s Connecticut license OR Connecticut state ID.

□ Spouse’s last W-2’s and tax filings.

□ Documents that demonstrate spouse has resided in the state at least six consecutive

months prior to the date of application for in-state tuition (the date you submit this

document).

□ Marriage Certificate.

Other Documents:

□ Proof of Voter Registration.

□ Others:__________________________________________________________________

________________________________________________________________________

5. You are a member of the military who is stationed in this state pursuant to military

orders:

Mandatory Documents:

□ Copy of your military orders.

Other Documents:

□ Proof of Voter Registration.

□ Others:__________________________________________________________________

________________________________________________________________________

Fill Online, Printable, Fillable, Blank FILLABLE CCSU Applicationfor In State Tuition6 25 15 (Central Connecticut State University) Form

Related forms

Fillable FILLABLE CCSU Applicationfor In State Tuition6 25 15 (Central Connecticut State University)

Fill Online, Printable, Fillable, Blank FILLABLE CCSU Applicationfor In State Tuition6 25 15 (Central Connecticut State University) Form

Related forms

First 20 documents completely FREE!