Office of Residence Life
Living with Family Confirmation 2019–20
International Student - Freshman or Sophomore
The University of Evansville Residency Requirement All students who attend the University of Evansville are required to live on campus for a designated
period of time as described under the University Residency Requirement Policy (see back of this form).
International students are allowed to commute if they will be living at in a shared local residence with close relatives such as parents, grandparents, uncles or aunts
who are siblings of the parent, brothers or sisters who are 21 years of age or older, or legal guardians.
Students who provide proof of living with a close family member, who does not reside at the home of this person, are not considered a commuter. A student enrolled
at the University who is living off-campus in violation of this policy will be held financially responsible for the room and meal charges for that period and will be
required to move on campus for the remainder of their time under the requirement.
This form is for international students who will be living with a close family member such as parents, grandparents, uncles or aunts who are
siblings of the parent, brothers or sisters who are 21 years of age or older, or a legal guardian during the 2019-20 academic year. A new form
must be completed for each academic year.
Before submitting this form, both student and family member must appear before the notary together with photo ID.
The University of Evansville has campus notaries available free of charge, but any Indiana State licensed notary may be used.
This notarized form must be returned to the Office of Residence Life one day prior to the residence hall opening for the corresponding semester
to avoid non-refundable housing and meal plan charges. Additional supporting documents must be provided at the time of submission of this
form:
1) Proof of family relationship such as birth certificates showing family relationship,
2) If the family member is not a US citizen, evidence that the individual has been granted temporary residence in the United
States must be provided such as H1B visas, TN visas, L1 visas. Please note that tourist or business B1/B2 visas are not accepted.
3) Proof of legal guardianship if applicable such as court records and certificates.
Student Name:
Last First MI
Family Member Name:
Last First MI
Student ID #:
Relationship:
(Mother, father, aunt, uncle, sibling, etc.)
Home Address:
Number & Street City State Zip County
Address may not be a P.O. Box.
Student:
I verify that I will be living with the family member below at least five (5) days per week at our local primary residence during the 2019-20 Academic Year. If I intend
to change this arrangement, I understand that I must obtain prior approval from the Office of Residence Life or move on-campus.
Student Signature: Date:
Family Member:
I verify that the above-mentioned student will be living with me at least five (5) days per week at our local primary residence during the 2019-20 Academic Year. If
s/he intends to move change this arrangement, I understand that s/he must obtain prior approval from the Office of Residence Life or move on-campus.
Family Member Signature: Date:
Indiana State Notary:
On , 20 before me, , personally
(notary)
appeared , who proved to me, on the basis of satisfactory evidence, to be the
(family member name)
person who signed this instrument. S/He acknowledged to me that s/he executed the same in support of the statements above in relation to the living arrangement
between her/him and the indicated student:
. Witness my hand and official seal.
(student’s name)
Notary Signature:
Printed Name of Notary:
Office of Residence Life Use:
