MASSACHUSETTS PUBLIC HIGHER EDUCATION INSTITUTIONS
IN-STATE TUITION ELIGIBILITY FORM
Last Name First Name MI ________
Street Address City State Zip Code _____________
SSN# or Student I.D. Number Date of Birth _________________________
Are you a U.S. Citizen? _______Yes _______ No. If you are not a U.S. Citizen, please state your immigration status in
Please check the in-state or reduced tuition eligibility category that applies to you:
_____ For Community College applicants: I have been a Massachusetts resident for six (6) continuous months and intend to
As proof of my intent to remain in Massachusetts, I possess at least 2 of the following documents, which I shall present to the
institution upon request. These documents are dated within one (1) year of the start date of the academic semester for which I
seek to enroll (except possibly for my high school diploma). The institution reserves the right to make any additional inquiries
regarding the applicant’s status and to require submission of any additional documentation it deems necessary. Please check-
off those documents you possess as proof of your intent to remain in Massachusetts.
_____Driver’s license _____Mass. High School Diploma
_____Car registration _____Voter registration
_____State/Federal tax returns
_____Utility bills _____Signed lease or rent receipt
_____Military home of record
_____Record of parents’ residency for unemancipated person
_____ I am an eligible participant in the New England Board of Higher Education’s Regional Student Program.
_____ I am a member of the armed forces (or spouse or unemancipated child) on active duty in Massachusetts.
Certification of Information
I certify that this information is true and accurate. I understand that any misrepresentation, omission, or incorrect information
shall be cause for disciplinary action up to dismissal, with no right of appeal or to a tuition refund.
Applicant Signature: Date________
Parent/Guardian Signature (Applicant is Under 18 Years Old): Date________
FOR OFFICIAL USE ONLY – DO NOT WRITE IN THIS BOX
I have reviewed the above information in order to determine this individual’s eligibility to receive the in-
Based on my review I have determined that this individual:
_____ IS eligible for the in-state tuition rate.
_____ IS NOT eligible for the in-state tuition rate.
_____ I am unable to make a determination at this time. The following additional information has been requested
from the applicant:
Authorized College Personnel: Date