Louisiana Tech University
Graduate School
RESIDENCY APPEALS FORM
Date: _______________________
Name: ___________________________________________________________________________________________
Last First Middle
Other names under which documents or records may be filed: ________________________________________
Social Security Number: __________________________ CWID _______________________________________
Present address: ____________________________________________________________________________________
____________________________________________________________________________________
City State Zip
_____________________ Email: ______________________________________________
Telephone
College/University from which you graduated: ___________________________________________________________
Date degree earned: ______________________
Date of first registration at Louisiana Tech: ____________ Date of last registration at Louisiana Tech: _____________
The number on the current RESIDENCY REGULATIONS list by which you feel you qualify for
IN-STATE evaluation: ______________
Complete a brief statement why you feel you now qualify as a Louisiana resident:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Please attach the appropriate supporting documents to the appeals form for the Residency Regulation that you are
appealing. An appeal will not be considered without these supporting documents. You will be notified of the decision by
letter.
FOR GRADUATE SCHOOL USE ONLY
________ Approved
________ Rejected
Date: _____________________ Signature: ______________________________________________________________
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