INDIANA
PETITION FOR INDIANA RESIDENT RECIPROCITY FEE EXEMPTION
Purpose and Instructions
The Ohio Board of Regents, Indiana Commission for Higher Education and Owens State Community College entered into an agreement whereby
any Indiana resident may enroll at Owens Community College in the Caterpillar Dealer Service Technician, AAS, or John Deere, AAS
programs and pay the Ohio resident fees instead of the out-of-state fees. All eligible students who want to receive in-state or resident tuition
rates under this agreement must petition for such rates when they plan to enroll. Failure to petition in the manner required and by the
submission deadline for the semester being petitioned will constitute a waiver of all rights under the terms of this agreement for that semester
of enrollment and any preceding semester of enrollment. Students in any other program will automatically be denied reciprocity under this
agreement.
It will be necessary for you to complete this petition in its entirety and provide the required documentation to determine your eligibility.
Incomplete petitions will not be given consideration for residency tuition rates. Subsequent to the completion of the processing of this petition
you may be assessed the tuition surcharge, you will be refunded the surcharge upon verification of your eligibility based upon the confirmation
you have met all necessary requirements of this reciprocity agreement.
Submit the petition and supporting documentation to the Oserve Office on the Toledo or Findlay Campus, or fax to 567-661-2101.
Questions via email about reciprocity can be directed to residency@owens.edu.
Requests for reciprocity consideration for prior semesters will not be granted.
Submission Deadlines
Spring semester: September 1
st
thru April 15th
Summer semester: February 1
st
thru June 15th
Fall semester: July 1
st
thru November 15th
Directions: Please PRINT in black ink
Indicate the semester for which you are requesting residency (select one): Summer Fall Spring Year: ______________
OCID (Owens College ID Number): ______________________________Social Security No. ________________________________
Name: _____________________________________________________________________________________________________
(Last) (First) (Middle)
Permanent Address: ____________________________________________________________________________________________
City: ________________________________ State: ____________ Zip: ________________ County: ______________________
Home Telephone: (________) - ____________- ______________________
If you are not a citizen of the United States, indicate your nationality and type of Visa
______________________________________________________________________________________
Provide copy of your permanent resident card or immigration documentation
Are you a dependent or spouse of an individual who has been a legal resident of Indiana for the last 12 consecutive months? Yes No
If yes, provide a copy of the Indiana parents’, legal guardian’s, or spouse’s most recent Indiana state and Federal income tax returns. Only
page 1 of both tax returns must be submitted and must show student listed as a dependent or spouse. Income information can be omitted.
Are you an independent student who has been a legal resident in Indiana for 12 consecutive months? Yes No
If yes, provide a copy of your most recent Indiana state and Federal income tax returns showing that you have claimed yourself. Only page 1
of both tax returns must be submitted and must show student listed as a dependent or spouse. Income information can be omitted.
Reciprocity Application Checklist:
The Indiana Resident Reciprocity Petition for Owens State Community College signed, dated and notarized.
A copy of your Indiana motor vehicle license (if licensed).
Copies of lease agreements, closing mortgage statements, or letter(s) from previous landlord(s) (must be notarized or on
letterhead) verifying your residency, parent’s or legal guardian’s residency in Indiana for the past 12 consecutive months
immediately preceding the semester you request Indiana resident reciprocity status.
Copies of parent’s, legal guardian’s or spouse’s most recent Indiana state and Federal income tax returns, if dependent. Copies of
your Indiana state and Federal income tax returns, if independent. Only page 1 of both tax returns must be submitted and must
show student listed as a dependent or spouse. Income information can be omitted.
Please complete page 2, the signature page
Mailing Address
Records Office
PO Box 10,000
Toledo
,
OH 43699
PETITION FOR INDIANA RESIDENT RECIPROCITY FEE EXEMPTION
Signature and Notarization
I understand it is my responsibility to maintain a twelve month residence in Indiana in order to receive the benefits of the Indiana
Reciprocity Agreement. It is my responsibility to maintain a current address of record with the College and I will notify the Records Office
with any address change, which may affect this agreement. I understand the submission of fraudulent information or failure to follow
specified instructions may interfere with my enrollment and residency status and I agree to abide by all college policies and procedures.
Ohio Revised Code Section 2921.11, Perjury, reads in part:
(A) No person, in any official proceeding, shall knowingly swear or affirm the truth of a false statement previously made when either
statement is material.
(B) A falsification in material, regardless of its admissibility in evidence, if it can affect the course or outcome of the proceeding. It is no
defense to charge under this section that the offender mistakenly believed a falsification to be immaterial.
The Undersigned being first duly sworn deposes and says that each and severally the answers and statements contained in the foregoing
pages are true and correct.
_________________________________________________________
Signature of Applicant Date
Subscribed and sworn to before me this ________ day of _________, _________
_____________________________________
Notary Public
State of Ohio, County of _____________________________,
(SEAL)
OR
State of Indiana, County of __________________________.
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