APPLICATION FOR IN-STATE TUITION RATES
1
2
L Number
3 U.S. Non-U.S.
4
How long have you resided in VA? Years Months
From (mm/yyyy) To (mm/yyyy)
6
7
8
9
10
11
Father Mother
3
U.S. Non-U.S.
4
How long have you resided in Virginia? Years Months
From (mm/yyyy)To (mm/yyyy)
6
Yes No
7
11
Yes
Yes
12
Me My Spouse
Yes No
Yes No
Yes No
Yes No
Please check all that apply to the student prior to the start of first semester.
If you (student) selected any of these, you may be considered
an Independent student and will complete Section II with your information.
If your parents/legal guardian/spouse provides 51% or more of your
financial support, or if you wish to be considered a dependent student,
Section II will be completed by your parents/legal guardian/spouse only.
This form must be completed to claim entitlement to Virginia in-state tuition rates pursuant to section 23.1-5, Code of Virginia. Answers must reflect information that is
true for at least 1 year prior to term of enrollment.
For at least one year prior to student's first semester at Longwood, will you have:
If you are a currently attending Longwood student and are requesting a reclassification of
your domicile status, please check here.
9
Yes
No, but I do for
another state.
No, but I do for
another state.
Do you hold a valid Virginia driver's license, learner's permit or DMV-
issued ID? Date issued ____________________________________
Do you live outside the state and commute to a work site in Virginia?
A. Earned at least $15,080 in the past year?
SECTION III - Military Students or Families
I do not own or operate.
Are you or spouse an active duty member or veteran of the
U.S. Armed Forces?
Filed a tax return or paid taxes in ANOTHER state?
Filed a tax return or paid Virginia income taxes on all earned income?
Are you an active duty member or veteran of the U.S. Armed Forces?
Are you married?
Are you a ward of the court, or were you a ward of the court until age 18?
Are both of your parents deceased and you have no legal guardian?
Are you 24 years old or older?
Are you a graduate or post-baccalaureate student?
Parent/Guardian Signature:
By checking this box and typing my full name below, I electronically sign this form.
By checking this box and typing my full name below, I electronically sign this form.
1 Parent/Guardian/Spouse Name
(Last, First, Middle)
If Independent student skip to #6
2
Relationship to the Student?
If not U.S., VISA type or Resident Alien #:
10
Owned or operated a motor vehicle with Virginia license plates?
8
Are you registered to vote in Virginia? Yes
SECTION I - To be completed by the STUDENT.
Date
Lancer's Name (Last, First Middle)
Yes
SECTION IV: Certification and Signature(s)
I certify that all of the information I provided in this application is true and accurate. I understand that this application is a legally binding document and that if I
provide fraudulent information, I may be subject to repayment of tuition or dismissal. I agree to furnish the University with supporting documentation related to
my application if I am requested to do so.
Student Signature:
Where have you lived for the past two years? List current address first. Include dates.
Where have you lived for the past two years? List current address first. Include dates.
Full Address including city, state, and zip
Full Address including city, state, and zip
SECTION II - Independent Student, Parent, Legal Guardian, or Spouse
Yes
A. If you are a Veteran, what is your date of retirement or discharge?
B. Do you have military orders to a duty station in Virginia?
(If yes, please provide copy.)
C. Is Virginia is your Home of Record, do you have temporary orders outside of
Virginia? (If Yes, please provide copy.)
D. Will the student use any military education benefits?
E. Have you paid income taxes to Virginia on all military income for the last year?
F. Is Virginia the military person's State of Legal Residence? (If yes, please
provide copy of the Leave/Earnings statement)
No
If not U.S., VISA type or Resident Alien #:
No, registered in
another state.
I do not have either.
I am not registered to vote.
