Rev. PL; na / rb / tr 01.08.2019 1
Youarepetitioningtoamendtheresidencyratedeterminedbythedatayouenteredonyournewapplicationortonotify
thecollegeofachangetoyourformerstatus.AccordingtoTitle5section54024,amongacceptableevidenceofintentto
establishCaliforniaresidenceincludesbutisnotlimitedto:
1. Ownershipofprincipalresidencepropertyorcontinuousoccupancyof
rentedorleasedpropertyinCalifornia.
2. RegisteringtovoteandvotinginCalifornia.
3. LicensingfromCaliforniaforprofessionalpractices.
4. Activemembershipinservicesorsocialclubs.
5. ShowingCaliforniaashomeaddressonfederalincometaxform.
6.
PaymentofCaliforniastateincometaxasaresident.
7. PossessingCaliforniamotorvehiclelicenseplate.
8. PossessingaCaliforniadriver’slicense.
9. EstablishingandmaintainingactiveCaliforniabankaccounts.
10. BeingthepetitionerforadivorceinCalifornia.
11. MaintainingpermanentmilitaryaddressorhomeofrecordinCalifornia
withthearmedforces.
AccordingtoTitle5section54024,conductinconsistentwithaclaimofCaliforniaresidenceincludesbutisnotlimitedto:
1. Maintainingvoterregistrationandvotinginanotherstate.
2. Beingthepetitionerforadivorceinanotherstate.
3. Attendinganoutofstateinstitutionasaresidentofthatotherstate.
4. DeclaringnonresidenceinCaliforniaforstateincometaxpurposes.
Ifyourcitizenship/immigrationstatusneedstobeclarified,youwillbeaskedtoenterthetitleofthedocumenta tionyou
are submitting as evidence of the immigrant status that allows you to estab lish California residency.Non U.S. Citizen
documentationtoproveimmigrationstatusmaybesuchthingsas:
1. Passport.
2. PermanentresidentcardI551.
3. ProofoforiginalfiledateI130,I94,Letterfromfilingattorney.
4. I688orI688AEmploymentAuthorizationCard.
SpecialConsiderationsforDACAstudentswhowillsubmitorhavesubmittedtheDreamApplication:
IfyouareaDACAstudentwhowillsubmitorwhohassubmittedtheDreamApplication,wealsorecommendthatyou
submitthefollowingadditionaldocumentation:
1. Proofofeither:
HavingattendedacombinationofCaliforniahighschool,adultschool,andcommunitycollegeforthe
equivalentofthree(3)yearsormore.
Havingthree(3)ormoreyearsofCaliforniahighschoolcourseworkandattendedacombinationof
Californiaelementary,secondary,andhighschoolofthree(3)yearsormore.
2. Proofofcom pletion:
GraduatedwithaCaliforniahighschooldiplomaorhavetheequivalent(i.e.,CaliforniaissuedGED,
CHSPE).
CompletedanAssociate’sdegreefromaCa liforniaCommunityCollege.
CompletedtheminimumrequirementsataCaliforniaCommunityCollegefortransfertothe
California
StateUniversityortheUniversityofCalifornia.
Please com pletepages2 through4,attach requireddocumentation,andsubmitinpersonat theAdmissions andRecords
Office(Building700,Lobby).Youwillbenotifiedviaemailfollowingreceiptofyourrequest.
PETITIONFORCORRECTIONORRECLASSIFICATIO NFROMNONRE SIDENT OR
FOREIGNSTUDE NT TUITIONSTATUSTOCALIFORNIARESIDENT
Attach2(minimum)documentsthat
containthefollowing:
Yourname
Californiaaddress
Datethatis366daysoldpriorto
firstdayofsemester.
Example:Ifthetermstartson
1/14/2019,thedocumentsmustbe
datedonorbefore1/13/2018.
Rev. PL; na / rb / tr 01.08.2019 2
WID#:
StudentName:
TheCaliforniaEducationCodeSection68044requiresthatthefinancialindependenceofanonresidentstudentseekingreclassification
asaresidentbeincludedinthefactorstobeconsideredinthedeterminationofresidence.Inordertoestablishfinancialindependence,
astudentseekingreclassificationmustmeetthefollowingcriteriaforthecurrent
andimmediatelyprecedingthreecalendaryears:(1)
thestudenthasnotbeenclaimedasanexemptionforstateandfederaltaxpurposesbyhisorhernonresidentparents,(2)thestudent
has notreceived more than$750 fromhis or hernonresident parents, and(3) the student hasnot lived
in thehome of his orher
nonresidentparentsformorethansixweeksinanygivenyear.
Failuretosatisfyallofthefinancialindependencecriteriafortheentireperiodwillnotnecessarilyresultinadenialofresidencystatus
if the durational requirement is met and the manifestation of intent is sufficiently strong.Financial independence is of greater
significanceforthecurrentandimmediatelyprecedingcalendaryear.
Failuretosatisfyallthreeofthefinancialindependencecriteria
for the current and immediately preceding calendar year will normally result in a determination of nonresidency.Financial
independenceorwantofit,forthesecondandthirdcalendaryearsimmediatelyprecedingtheyearinwhichreclassificationisrequested
will be
considered together with all other relevant factors in determining intent with no special weight attached to the financial
independencefactor.Therefore,pleaseanswerallofthefollowingquestions:
1.Indicateyoursourceoffinancial supportin: 
2018present:________________________________________________________________
20182017:_________________________________________________________________
20172016:_________________________________________________________________
2. Didorwillyoufilestateincometaxreturnsfortheyear:
2018Yes No
Ifyes,liststate:______
2017Yes No
Ifyes,liststate:______
2016Yes No
Ifyes,liststate:______
Ifyouanswered"yes"foreachoftheseyears,pleaseskipquestions3through6andproceedtopage3aftersigningthispage.
3. Didyourparentsorwillyourparentsclaim youas anexemptionontheirstateandfederalincom etaxreturnsfiledin
theyear:
2018Yes No
Ifyes,liststate:______
2017Yes No
Ifyes,liststate:______
2016Yes No
Ifyes,liststate:______
Ifyouanswered"no"foreachoftheseyears,pleaseskipquestions4through6andproceedtopage3aftersigningthispage.
4. AreyourparentsCaliforniaresidents?Yes No
Indicatethestateofresidenceforeachofyourparents:
Mother:___________________________
Father:___________________________
5. Didyouorwillyoulivewithyourparentsformorethansixweeksin:
2018presentYes No 20172018Yes No 20162017Yes No
6. Didyouorwillyoureceivemorethan$750infinancialassista nce fromyourp arentsin:

2018presentYes No 20172018Yes No 20162017Yes No
By signing this form, you understand that any misrepresentation of information provided may result in dismissal or disciplinary action in accordance with Student
DisciplinaryActionand/orafinancialobligationthatmustbepaidinaccordancewiththeprocessingandcollectionoftuitionandfeepayments.Further,youunderstand
thatSTATERESIDENCY
CHANGESWILLNOTBEMADERETROACTIVELYandthatthedeadlinetomakearesidencechangeispriortothestartoftheenrolledterm.
StudentSignature:________ __ ___ ___ ___ __ ___ ___ ___ __ Date:_____ _ ___ ___ __ ___ ___ __
Pleaseproceedtothenextpage.
STUDENTFINANCIALINDEPEND EN CESTATUS
Rev. PL; na / rb / tr 01.08.2019 3
WID#:
StudentName:
RESIDENCEADDRESS(LEGAL/PERMANENTADDRE SS.DONOTUSEPOBOXNUMBER.)
___________________________________________________________________________________________________________________________
Number&StreetCityZipCode
Ihavelivedatthisaddresssince______/______/____________
MonthDayYear
Iflessthantwoyears,showpreviousaddressesbelow:
___________________________________________________________________________/____________to______/____________
Number&Street City ZipCode MonthYearMonthYear
___________________________________________________________________________/____________to______/____________
Number&Street City ZipCode MonthYearMonthYear
WhendidyourpresentstayinCaliforniabegin?______/______/____________
MonthDayYear
Dateofbirth______/______/____________
MonthDayYear
PLEASEANSWERTHEFO LLO WINGQUESTIONS: YES NO
1. AreyouregisteredtovoteinCalifornia?....................................................................................................................................
2. Doyoumaintainvoterregistrationinanotherstate?.................................................................................................................
3. Inthelasttwoyears,didyouattendanoutofstatecollegeoruniversityasaresidentofthatotherstate?..........................
4. DoyoupayCaliforniastateincometaxasaresident?................................................................................................................
5. Inthelasttwoyears,didyoupayincometaxinanotherstate?................................................................................................
6. Inthelasttwoyears,wereyouapetitionerfordivorceinanotherstate?................................................................................
7. DoyoucurrentlypossessaCaliforniadriver’slicense?..............................................................................................................
8. Areyoureceivingscholarshipmoniesfromanagencyinanotherstate?..................................................................................
9. Doyourparentsclaimyouasadependentforincometaxpurposes?......................................................................................
10. Ifyouownanautomobile,doyoupossessCaliforniamotorvehiclelicenseplates?................................................................
11. DoyouownresidentialpropertyorhaveyoucontinuouslyoccupiedrentedorleasedpropertyinCalifornia?.....................
12. AreyoulicensedfromCaliforniaforprofessionalpractice?......................................................................................................
13. DoyoumaintainactivemembershipinserviceorsocialclubsinCalifornia?............................................................................
14. Areyourspouse,children,orothercloserelativespresentinCalifornia?................................................................................
15. DoyoushowCaliforniaasyourhomeaddressonyourfederalincometaxform?...................................................................
16. DidyoumaintainCaliforniaasyourpermanentmilitaryaddressorhomeofrecordwhileinthe
armedforces?
NotApplicable.................................................................................................................................................
17. HaveyouestablishedanddoyoumaintainactiveCaliforniabankaccounts?
...........................................................................
18. DidyouattendhighschoolinCalifornia?(Ifno,proceedtonextpage).....................................................................................

19. DidyouobtainaCaliforniahighschooldiploma?......................................................................................................................
20. HowmanytotalyearsdidyouattendhighschoolinCalifornia?...............................................................................................
_________
Pleaseproceedtothenextpage.
PETITIONFORRECLASSIFICATIO N FROM NONRESIDENT
STATUSTOTHATOFCALIFORNIARESIDENT‐PartI
Rev. PL; na / rb / tr 01.08.2019 4
WID#: 
StudentName:
PETITIONFORRECLASSIFICATIONFROMNONRESIDENTSTATUSTOTHATOFCALIFORNIARESIDENT‐PartII
HaveyoupreviouslysubmittedaPetitionforReclassification?______Ifso,whatdate?____________
HaveyoueverattendedChabotCollegeand/orLasPositasCollegeasaforeignstudentattendingonanF1orM1studentvisa?Yes No 
Ifyes,pleasecontacttheInternationalStudentAdmissionsOffice.
Whatisyourcurrentnationalstatusatthistime?
NonU.S.Citizendocumentationtoprove
immigrationstatusmaybesuchthingsas:
passport,permanentresidentcardI‐551,proofof
originalfiledate,I‐130,I‐94.I‐688orI‐688A
EmploymentAuthorizationCard.
U.S.Citizen
ImmigrantPermanentResident
TemporaryResident(PermRespending)
PoliticalAsylum/RefugeeApplicant
Visa(indicatetype________________)
Other___________________________________________________________
DeferredActionforChildhoodArrivals(DACA)
IfyouareaDACA studentwhowillsubmitorwhohassubmittedtheDreamApplication,thenpleasereadandsig nthefollow ingaffida vitfornon
citizenswithoutcurrentorvalidimmigrationstatus:
Bysigningthesignaturelinebelow,IherebystatethatifIamanoncitizenwithoutacurrentorvalidimmigrationstatus,Ihavefiledan
applicationtolegalizemyimmigrationstatusorwillfileanapplicationassoonasIameligibletodoso.
StudentSignature____________________________________________Date:________________________
Ifyourcitizenship/immigrationstatusneedstobe clarifie d,youmustprovidethefollowing:
1. Documentationthatprovesyourcitizenship/immigrationstatusallowingyoutoestablishCaliforniaresidencydatingbackatleast366daysprior
tothefirstdayofthesemestertowhichyouhaveapplied.
2. Twodocuments(listingyournameandCAresidence)thatproveyouhaveresidedintheStateofCaliforniaforatleast366dayspriortothefirst
dayofthesemestertowhichyouhaveapplied.
Ifonlyyourstate residencenee ds tobeclarified,youmustprovidethefollowing:
1. Twodocuments(listingyournameandCAresidence)thatproveyouhaveresidedintheStateofCaliforniaforatleast366dayspriortothefirst
dayofthesemestertowhichyouhaveapplied.
NOTE:Failuretosubmitrequireddocumentationwillresultinadenialofyourreclassificationpe tition.

Nameofdocument Document# DateofIssuance ExpirationDate




PleasestatewhyyourdocumentsareevidenceyoushouldbeclassifiedasaCaliforniaresident:
IcertifyunderpenaltyofperjurythattheinformationonPartsIandIIofthisresidencequestionnaireiscorrectandIunderstandthatfalsificationor
failuretoreportchangeinresidencemayresultinmydismissalordisciplinaryactioninaccordancewithStudentDisciplinaryActionand/orafinancial
obligationthatmustbepaidinaccordancewiththeprocessingandcollectionoftuitionandfeepayments.Further,IunderstandthatSTATERESIDENCY
CHANGESWILLNOTBEMADERETROACTIVELYandthatthedeadlinetomakearesidencechangeispriortothestartoftheenrolledterm.
StudentSig nature_______________________________________________________Date______________Term____________________
OFFICEUSEON LY
CAResident(both
qualific ationsmustbe
met)
Providedevidenceofintent
topermanentlyresideinCA
atleast1yearpriortoterm
start
Providedevidenceofhaving
residedinCAfor1year
priortotermstart
OutofStateResident(checkreason)
CitizenOtherU.S.State
NoncitizenImmigrantVisa,hasn’tlivedinCA
1yearpriortotermstart
NoncitizenImmigrantVisa,intentto
permanentlyresideinCAdocumentdated
lessthan1yr.priortotermstart
Noamendment.Outofstatecoderemains.
NonresidentTuition
Noncitizen‐
Nonimmigrant
Visa/Undocumented
Noamendment.
Nonresidentcode
remains.
RESC/RESL REAC/REAL
ABEC/ABEL REDC/REDL
Effective/DenialTerm:
Date:
DateBanneramended:
Initials:
SGASTDN:
StudentNotified:
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