Student Information
The state where I legally reside is: _______________________________________________________________________
NAME OF STATE
I have been a resident of this state since: _________________________________________________________________
MONTH/YEAR
______________________________________________________________________________________________________________________________________________________
STUDENT’S SIGNATURE DATE
IMPORTANT: If you completed the FAFSA as a dependent student, parental information and signature below are required.
If you completed the FAFSA as an independent student, parental information and signature below are not required.
We cannot accept digital signatures.
Parent Information (if dependent)
The state where my parent(s) legally reside is: _______________________________________________________________________
NAME OF STATE
My parent(s) have been a resident of this state since: _________________________________________________________________
MONTH/YEAR
______________________________________________________________________________________________________________________________________________________
PARENT’S SIGNATURE DATE
2019–2020
Statement of Residency Information
Student Financial Services • 1 Ferncroft Road • Danvers, MA 01923-0840
978-762-4189 www.northshore.edu/paying/financial-services
sfs@northshore.edu
Required (please print) RES
Student ID#
N 0 0
Last Name: __________________________________________
First Name: __________________________________________
2/1/19
In order to receive state funded financial aid, you need to provide
residency information. Our records indicate that you, or your
parents (if applicable), did not provide this information on your
Free Application for Federal Student Aid (FAFSA). Please indicate
your residency below and send it back to us immediately. Residency
(domicile) is your true, fixed, and permanent home. If you moved
into a state for the sole purpose of attending a college, do not count
that state as your legal residence.
