Galveston College is an Equal Opportunity/Affirmative Action Institution
I meet all of the following criteria and am eligible to pay in-state tuition at Galveston College pursuant to HB 1403:
- Graduated from Texas high school or have obtained a Texas GED Certificate/High School Equivalency
- Lived in Texas for three (3) consecutive years prior to graduating from a Texas high school or receiving a Texas
GED certificate
- Resided in Texas for the 12 months prior to the census date of the term for which I will enroll
- Have not attended an institution of higher education prior to Fall 2001
Last First Middle Maiden
Mailing Address
City State Zip Code
This notice is to certify that I will file an application to become a PERMANENT RESIDENT of the United States of America
as soon as I am eligible to do so.
I am a graduate of High School in the State of Texas. I am ________ years of age and
certify under penalty of perjury under the laws of the United States of America that the application and the evidence
submitted with it is true and correct.
Student Name (print) Student Signature Date
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Permanent Resident Notice
You are admitted to Galveston College under House Bill 1403 as an undocumented student. It is your responsibility to file
an application to become a PERMANENT RESIDENT of the United States of America as soon as you are eligible to do
so. If you do not, you will hinder your employment eligibility.
Student Signature Date
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Notarization
Before me the undersigned authority, on this day personally appeared
Who after being duly sworn by me, upon oath did state that the information contained in the forgoing Affidavit of Intent is
true and correct.
Sworn and subscribed before me this day of , 20 .
Notary Public In and For
The State of County of My commission expires
Notary Public Signature: __________________________________
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