Fillable FLORIDA RESIDENCY DECLARATION FOR TUITION PURPOSES (Palm Beach State College)

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FLORIDA RESIDENCY DECLARATION FOR TUITION PURPOSES (Palm Beach State College)

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Rule6A‐10.044,F.A.C.,FormFRD‐1
EffectiveDecember,2015 Page1
A Florida “resident for tuition purposes” is a person who has, or a dependent person whose parent or legal
guardian has, established and maintained legal residency in Florida for at least twelve (12) consecutive months
preceding the first day of classes of the term for which Florida residency is sought.
Residence in Florida must be a bona fide domicile rather than for the purpose of maintaining a
residence incident to enrollment at an institution of higher education.
To qualify as a Florida resident for tuition purposes, you must be a U.S. citizen, a foreign national in a
nonimmigrant visa classification that grants you the legal ability to establish a bona fide domicile in the
United States, a permanent resident alien, parolee, asylee, Cuban-Haitian entrant, legal alien granted
indefinite stay by the U.S. Citizenship and Immigration Services, or other qualified alien as defined
under federal law. Other persons not meeting the twelve-month legal residence requirements may be
classified as Florida residents for tuition purposes only if they fall within one of the limited special
categories authorized by the Florida Legislature pursuant to section 1009.21, Florida Statutes (see
“Qualification by Exception” below). All other persons are ineligible for classification as a Florida
“resident for tuition purposes.”
Living in or attending school in Florida will not, in itself, establish legal residence. Students who depend
upon out-of-state parents for support are presumed to be legal residents of the same state as their
parents.
Residency for tuition purposes requires the establishment of legal ties to the state of Florida. A student
must verify that the student has broken ties to other states if the student or, in the case of a dependent
student, his or her parent has moved from another state.
Please print if submitting hard copy.
Name of Student: __________________________________________ Student ID______________________
Date of Birth: _________________________
Student is
a: [ ] U.S. Citizen [ ] Non-U.S. Citizen [ ] Permanent Resi
dent [
] O
t
her
Alien Registration Number: _____________________________ Issue Date: _________________________
Visa Category_________
All non-U.S. citizen students seeking classification as a Florida resident for tuition purposes are required to
submit documentation of their legal status in the United States as issued by the United States Citizenship and
Immigration Services office.
NON-FLORIDA RESIDENT
I do not qualify as a Florida resident for tuition purposes for the term for which this application is submitted. I
understand that should I qualify for a future term, it will be necessary for me to submit an updated Residency
Declaration while providing prescribed, supporting documentation to substantiate as “reclassification” of my
status. I understand being classified as a non-Florida resident will not exclude me from the possibility of
receiving a waiver
to cover part or all of the out-of-state fee as defined in s. 1009.26, Florida Statutes.
Submission of an updated Residency Declaration must occur prior to the beginning of the term for which
residency is sought. I do not have to complete any further portion of this form, with the exception of signing
below.
Student Name: ___________________________________________________________________________
FLORIDA RESIDENCY DECLARATION FOR TUITION PURPOSES
Signature of Student:________________________________________________Date: __________________
Print Form
Rule6A‐10.044,F.A.C.,FormFRD‐1
EffectiveDecember,2015 Page2
TO BE COMPLETED BY THE STUDENT SEEKING FLORIDA RESIDENCY FOR TUITION
PURPOSES:
I qualify as a resident for tuition purposes, as defined by s. 1009.21, Florida Statutes, for the term for which this
application is submitted . I understand that it will be necessary for me to present evidence of residency for
tuition purposes, supporting my claim as a Florida resident for tuition purposes. I have read the residency
information on qualifying as a dependent or independent student, and declare that: (select one of the options
below):
I am a dependent student, as defined by s. 1009.21(1)(a), Florida Statutes, in that I am eligible to be
claimed as a dependent under the federal income tax code by the claimant below. The claimant is my
“parent” as defined by s. 1009.21(1)(f) Florida Statutes, (i.e., either or both parents of the student,
anguardian of a student, or any person in a parental relationship to the student). My parent has
maintained legal residence in Florida for at least the past 12 consecutive months. As defined by section
1009.21(1)(d) Florida Statutes, "‘legal resident’ or ‘resident’ means a person who has maintained his or
her residence in this state for the preceding year, has purchased a home which is occupied by him or her
as his or her residence, or has established a domicile in this state pursuant to s. 227.17.” A copy of your
parent’s tax return may be requested to establish dependence.
I am an independent person who has maintained legal residence in Florida for at least the past 12
consecutive months. I provide more than 50% of my own support. An independent student generally
includes a person who is at least 24 years old, married, a graduate or professional student, a veteran, a
member of the armed forces, a ward of the court, or someone with legal dependents other than a spouse,
pursuant to the United States Department of Education for the purposes of federal financial aid eligibility.
There may be limited cases where a person under the age of 24 years old may qualify as an independent
student. Such students will be required to verify independence (including financial independence.) A copy
of your tax return may be requested to establish independence.
I meet residency requirements
through one of the
Qualifications
by
Exception below
(ch
eck appropriate
exception).
TERM OF APPLICATION: (check one): [ ] FALL [ ]SPRING [ ]SUMMER YEAR: 20 ______
QUALIFICATION BY EXCEPTION (to be completed by the student.)
As provided in s. 1009.21, Florida Statutes, I qualify for residency based on the following permitted exception
(documentation required):
[ ] I am a qualified beneficiary under the terms of the Florida Prepaid College Program (s. 1009.98, Florida
Statutes.) (Required: Copy of Florida Prepaid Recipient card.)
[ ] I am married to a person who has maintained legal residence in Florida for at least the past 12 consecutive
months. I now have established legal residence and intend to make Florida my permanent home.
(Required: copy of marriage certificate and/or other documents required to establish residency.)
[ ] I was previously enrolled at a Florida state postsecondary institution and classified as a Florida resident for
tuition purposes. I am transferring to another Florida state postsecondary institution within 12 months of
the previous enrollment. (Required: Evidence of previous enrollment as a FL resident)
[ ] I was previously enrolled at a Florida state postsecondary institution and classified as a Florida resident for
tuition purposes. I abandoned my Florida domicile less than 12 months ago and am now re-establishing
Florida legal residence.
[ ] Active duty members of the Armed Services of the United States residing in this state and their spouses
and dependent children, and active drilling members of the Florida National Guard. (Required: Copy of
military orders or DD2058 showing home of record.)
[ ] Active duty members of the Armed Services of the United States and their spouses and dependents
attending a Florida College System institution or state university within 50 miles of the military
establishment where they are stationed, if such military establishment is within a county contiguous to
Florida. (Required: Copy of military orders.)
Rule6A‐10.044,F.A.C.,FormFRD‐1
EffectiveDecember,2015 Page3
[ ] United States citizens living on the Isthmus of Panama, who have completed 12 consecutive months of
college work at the Florida State University Panama Canal Branch, and their spouses and dependent
children. (Required: Copy of marriage certificate or proof of dependency.)
[ ] Full-time instructional and administrative personnel employed by state public schools and institutions of
higher education and their spouses and dependent children. (Required: Employment Verification)
[ ] Students from Latin America and the Caribbean who receive scholarships from the federal or state
government. Any student classified pursuant to this paragraph shall attend, on a full-time basis, a Florida
institution of higher education. (Required: proof of scholarship and Latin America or Caribbean residency.)
[ ] Southern Regional Education Board’s Academic Common Market graduate students attending Florida’s
state universities. (Required: Certification letter from State Academic Common Market Coordinator.)
[ ] Full-time employees of state agencies or political subdivisions of the state when the student fees are paid
by the state agency or political subdivision for the purpose of job-related law enforcement or corrections
training. (Required: Employment verification/payment agreement).
[ ] McKnight Doctoral Fellows and Finalists who are United States citizens. (Required: Verification from
graduate studies.)
[ ] United States citizens living outside the United States who are teaching at a Department of Defense
Dependent School or in an American International School and who enroll in a graduate level education
program which leads to a Florida teaching certificate. (Required: Proof of enrollment in graduate program
for FL teaching certificate.)
[ ] Active duty members of the Canadian military residing or stationed in this state under the North American
Air Defense (NORAD) agreement, and their spouses and dependent children, attending a Florida College
System institution or state university within 50 miles of the military establishment where they are stationed.
(Required: Proof of active duty membership for specified purpose.)
[ ] Active duty members of a foreign nation’s military who are serving as liaison officers and are residing or
stationed in this state, and their spouses and dependent children, attending a Florida College System
institution or state university within 50 miles of the military establishment where the foreign liaison officer is
stationed. (Required: Proof of active duty membership for specified purpose.)
TO BE COMPLETED BY THE CLAIMANT/PERSON CLAIMING FL RESIDENCY:
Note: If the student is a dependent, the parent is the claimant and will complete this section and provide
evidence of residency supporting the claim. If the student is independent, the student is the claimant and will
complete this section and provide evidence of residency supporting the claim. No single document shall be
conclusive in establishing residency. Additional documentation, other than what is prescribed, may
be requested in some cases. All documentation provided is subject to verification. Evidence of ties to
another state may result in denial of Florida residency for tuition purposes.
Claimant/Name of Person Claiming FL Residency:________________________________________________
Claimant’s Relationship to Student:____________________________________________________________
Claimant’s Address: _______________________________________________________________________
________________________________________________________________________________________
Telephone Number:________________________________________________________________________
Date Claimant began establishing legal FL residence (if upon birth, enter birthdate): _____________________
PROVISION OF DOCUMENTS TO SUPPORT CLAIM OF FLORIDA RESIDENCY
Per s. 1009.21(3)(c), Florida Statutes, the residency determination must be documented by the
submission of written or electronic verification that includes two or more of the documents identified
below. No single piece of evidence shall be conclusive.
A. Claimant must provide at least one of the following of his/her personal documentation:
[ ] Florida Voter's registration card Number:____________________________________ Issue Date:________________
[ ] Florida Driver's license. Number:____________________________________ Original Issue Date:__________________
Current Issue Date:__________________
Rule6A‐10.044,F.A.C.,FormFRD‐1
EffectiveDecember,2015 Page4
[ ] Florida State identification card. Number:____________________________ Original Issue Date:__________________
Current Issue Date:___________________
[ ] Florida Vehicle registration. Number:_______________________________ Original Issue Date:___________________
Current Issue Date:___________________
[ ] Proof of permanent home in Florida occupied as primary residence for 12 consecutive months prior to
the student’s enrollment. (Required: document such as a deed or other evidence of title to property
used as primary residence, a homeowner’s policy, a title insurance policy, evidence of a property tax
payment on the primary residence, multiple leases reflecting a Florida address, or a lease of multiple
years’ duration.)
[ ] Proof of a homestead exemption in Florida. (Required: document from the county tax collector
demonstrating the application of a homestead exemption to the claimant’s primary residence.)
[ ] Official transcripts from a Florida high school for multiple years (2 or more years), if the Florida high
school diploma or GED® was earned within the last 12 months. (Required: transcript)
(Dates of Attendance:_____________________ Graduation Date: ___________________.
[ ] Proof of permanent full-time employment in Florida for at least 30 hours per week for a 12-month
period. (Required: pay stubs or W-2 form for past 12 consecutive months and/or verification from
employers, and/or an IRS 1099 with verification of employment for the past 12 consecutive months
from an employer.)
B.
Claimant may provide one or more documents from the following categories to demonstrate
residency in Florida (to be used in conjunction with one document from above):
[ ] Declaration of domicile in Florida in accordance with s. 222.17, Florida Statutes.
[ ] Florida professional or occupational license.
[ ] Florida incorporation.
[ ] Document evidencing family ties in Florida
[ ] Proof of membership in a Florida-based charitable or professional organization.
[ ] Any other documentation that supports your request for resident status, including, but limited to, utility
bills and proof of 12 consecutive months of payments; a lease agreement and proof of 12 consecutive
months of payments; or an official state, federal, or court document evidencing legal ties to Florida.
RESIDENCY DECLARATION:
I, the undersigned, hereby declare that I have read the foregoing document and that the facts stated in it are
true and further affirm the authenticity of the information provided on all pages of this Residency Declaration. I
understand that any false or misleading information on this Residency Declaration, or provided in support of this
Residency Declaration, will subject me to penalties pursuant to section 837.06, Florida Statutes, for making a
false statement. I give permission for the institution to review or examine any and all documents and records,
including those accessible electronically, which may assist in support of my claim as a Florida resident for
tuition purposes.
Student Name (Please Print): ________________________________________________________________
Claimant Name (if not the Student):____________________________________________________________
Signature of Claimant: ___________________________________________________ Date: _____________
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FLORIDA RESIDENCY DECLARATION FOR TUITION PURPOSES (Palm Beach State College)

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Completed 23 July 2020

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