Fillable Form 1.: RESIDENCY VERIFICATION FORM (Baltimore City Community College)

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Form 1.: RESIDENCY VERIFICATION FORM (Baltimore City Community College)

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The Form 1.: RESIDENCY VERIFICATION FORM (Baltimore City Community College) form is 2 pages long and contains:

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Country of origin: US
File type: PDF

U.S.A. forms for Baltimore City Community College

BROWSE BALTIMORE CITY COMMUNITY COLLEGE FORMS

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Name: ___________________________________________________________________________________
Date of Birth: ______________________________________________________________________________
Baltimore City Community College requires one of the following original document(s) to establish Maryland residency for in-state tuition:
This section must be verified and completed by an Admissions Officer
MARYLAND RESIDENCY VERIFICATION REQUIRED (Please submit one from each applicable section)
1.
Evidence of Maryland residency for three consecutive months prior to start of semester.
_____ Maryland Driver’s License or Identification card ID# _________________________________________
_____ Maryland Vehicle Registration
_____ Maryland Taxes (certified copy of MD tax forms 502 or 503)
_____ Maryland Voter Registration card
_____ Maryland home mortgage or rental agreement in your name with address indicated
_____ Maryland high school transcript/diploma (students who graduated during the current academic year)
_____ Maryland Dream ACT (additonal documentation required to qualify)
_____ Military Service(active or retired veterans/dependents with appropriate military documentation-DD214/
Military ID)
_____ Other _____________________________________________________________________________
FOREIGN BORN STUDENT UNITED STATES LEGAL RESIDENCY VERIFICATI ON REQUIRED
1. Evidence of lawful residence in the United States.
(Student must show original United States Citizenship & Immigration Services documentation).
_____ Permanent Resident Card
_____ Temporary Protective Status (TPS)
_____ USCIS stamp inside passport indicating lawful resident status (ie: refugee, permanent r
esidency,
temporary permanent residency, asylum or other): ___________________________________________
_____ USCIS stamp on I-94 arrival/departure card indicating lawful resident status (ie: refugee, permanent
residency, temporary permanent residency, asylum or other: ____________________________________
_____ Notice from USCIS or form I-485-I-551, I-151, I-688, indicating status of petition for lawful resident status.
_____ United States Naturalization Certificate (required for students changing their current immigration or
citizenship status)
_____ Other: _____________________________________________________________________________
OR
2. Evidence of marriage to U.S. citizen or permanent resident
_____ Marriage License and spouse Permanent Resident Card (if non U.S citizen) AND
_____ Letter from the USCIS indicating pending or approved petition for lawful resident status
Petition for Permanent Residency (Form I-485, I-551 or I-151 or I-688) must be on file with USCIS.
SENIOR CITIZEN DISCOUNT VERIFICATION REQUIRED
Proof of Age
____ Birth Certificate ____ Maryland Driver’s License or Identification Card ____ United States Passport
OFFICE USE ONLY
Bill code: ______ 01 In-state ______ 02 Out-of-state / International ______ SR (Senior Citizen Discount)
Verified by: _____________________________________________________ Date: ___________________
Part 2
2/16
RESIDENCY VERIFICATION FORM
RESIDENCY VERIFICATION FORM
Office of Admissions
2901 Liberty Heights Avenue
Baltimore, Maryland 21215
Ofce: 410-462-8300 • Fax: 410-462-8345
Personal Data
Name ______________________________________________________________________________________________________
Street ______________________________________________________________________________________________________
City ____________________________________________________ State ________________ Zip Code ____________________
Home Phone ____________________________________ Alternate Phone _____________________________________________
Email Address ________________________________________________________________________________________________
PLEASE PRESENT VALID IDENTIFICATION UPON SUBMISSION OF DOCUMENT
DetermInatIon oF resIDenCe
There are two tuition rates, one for State of Maryland residents and one for out-of-state and foreign non-immigrant
residents. A person is considered a State resident who has been domiciled in Maryland for not less than three consecutive
months prior to enrollment. Domicile means a person’s permanent place of residence where physical presence and
possessions are maintained and where the person intends to remain indefinitely. Additionally, the domicile of any student
who received more than one-half of his or her financial support from others within the last 12 months is the domicile
of the person contributing the greatest portion of support, without regard to whether the parties are related by blood or
marriage and without regard to student’s current address. A student under the age of 18 years of age may claim his/her
residence as that of his/her parents or legal guardians. Some non-immigrant visa types may not be eligible for in-state
tuition depending upon their United States Citizenship and Immigration Services (USCIS) visa status. For more
information, contact the Office of Admissions, or refer to the BCCC website: www.bccc.edu.
resIDent aFFIDavIt
I hereby certify that I have lived or will have lived in the state of Maryland for at least three months prior to the first day of classes and
would be able to substantiate this claim with appropriate documentation (see Evidence of Maryland Residency indicated in Part 2).
I also understand that false statement may be grounds for my dismissal from the college and/or retroactive adjustment of tuition.
Select One
q United States Citizen q Permanent Resident/Resident Alien q O
ther (Visa Type): ___________________
Signature_________________________________________________________ Date ____________________
Part 1
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Form 1.: RESIDENCY VERIFICATION FORM (Baltimore City Community College)

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Completed 24 January 2021

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