Fillable Nonresident Students TuitionWaiver Application

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Nonresident Students TuitionWaiver Application

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Albany State University
University System of Georgia
Petition for Classification of Students for Tuition Purposes
Section I - Overview
Students who have been classified as out-of-state for tuition purposes who believe that the submission of additional information could
alter that decision, may submit this petition and supporting documentation to request to be considered for reclassification. This
petition should only be submitted by students who have been notified that they have been classified as out-of-state for tuition
purposes.
Prior to completing this petition, students should carefully review these instructions. For more information about the classification of
students for tuition purposes, students should review Section 4.3.2 of the Board of Regents Policy Manual, Classification of Students for
Tuition Purposes, found online at http://www.usg.edu/policymanual/section4/policy/4.3_student_residency/.
Some students not eligible to be classified as in-state for tuition-purposes may be eligible for an out-of-state tuition waiver. For more
information about the available out-of-state tuition waivers, students should review Section 7.3.4.1, Out-of-State Tuition Waivers,
found online at http://www.usg.edu/policymanual/section7/policy/7.3_tuition_and_fees/#p7.3.4_out-of-
state_tuition_waivers_and_waivers_of_mandatory_fees.
Students wishing to file a petition should contact the Office of Academic Services and Registrar for filing deadlines and procedures.
Who may be eligible for in-state status for tuition purposes?
The criteria considered when determining a student’s eligibility for in-state tuition depends on a student’s status as an independent or
dependent student. A dependent student is an individual under the age of 24 who receives financial support from a parent or United
States court appointed legal guardian. An independent student is an individual who is not claimed as a dependent on the federal or
state income tax returns of a parent or United States court appointed legal guardian, and whose parent or guardian has ceased to
provide support and rights to that individual’s care, custody, and earnings.
An independent student who has not lived outside of Georgia or who:
o Moved to the state for reasons other than attending a post-secondary educational institution;
o Abandoned all ties to their previous state or country of residence;
o Has taken appropriate steps to assume the responsibilities of a Georgia resident;
o Has lived in the state for at least 12 continuous months immediately preceding the first day of classes;
o Receives no financial assistance from outside of Georgia;
o Is not claimed as a dependent on the taxes of someone who resides outside of Georgia; and
o Is a U.S. citizen, Lawful Permanent Resident, refugee, asylee, or other eligible noncitizen as defined by federal Title IV
regulations.
A dependent student whose parent or U.S. court-appointed legal guardian has not lived outside of Georgia or whose parent or
U.S. court-appointed legal guardian:
o Moved to the state for reasons other than attending a post-secondary educational institution;
o Abandoned all ties to their previous state or country of residence;
o Has taken appropriate steps to assume the responsibilities of a Georgia resident;
o Has lived in the state for at least 12 continuous months immediately preceding the first day of classes;
o Receives no financial assistance from outside of Georgia; and
o Is a U.S. citizen, Lawful Permanent Resident, refugee, asylee, or other eligible noncitizen as defined by federal Title IV
regulations.
o In addition to the above, a dependent student of a Georgia-domiciled parent must either:
A. Be a graduate of a Georgia high school; or
B. Be claimed as a dependent on their Georgia-domiciled parent’s state or federal income taxes.
A dependent student of a Georgia-domiciled U.S. court-appointed legal guardian must provide evidence that the
guardianship was not appointed to avoid payment of out –of-state tuition.
Section II – Supporting Documentation
The following are examples of supporting documentation which may be submitted as evidence of domicile. The submission of any of
the following documentation does not guarantee reclassification as an in-state student. The tuition classification officer will consider
the totality of circumstances when making a tuition classification determination.
Students under the age of 24 should submit documentation related to the domicile of their parent(s) or U.S. court-appointed legal
guardian, in addition to documentation related to their own domicile.
1. Signed statement of reason for coming to Georgia.
2. Certified or notarized copy of state and/or federal income tax return(s) filed for the most recent tax year.
3. Signed statement of intent to file taxes for the current year.
4. Copy of most recent W-2.
5. Copies of paystubs or Leave Earnings Statements (LES) for the previous year.
6. Letter/statement from current and/or previous employer(s) verifying any employment during the last 12 months. The
letter/statement should be on company letterhead and should indicate dates of employment and whether that employment
was full or part-time.
7. Copy of the lease or deed for residence(s) maintained during the past 12 months. If the lease or deed is not in your name, a
notarized statement from the lessee or deed holder stating that you reside with them and for how long.
8. Receipts from the payment of property taxes.
9. Copies of homestead exemption documents.
10. Copy of birth certificate or guardianship paperwork issued by a United States court.
11. Copy of a valid vehicle registration for the State of Georgia.
12. Copy of a valid Georgia Driver’s License or state-issued ID.
13. Copy of voter registration.
14. Copy of any business or professional license(s) which may have been obtained in Georgia.
15. Copies of bills, such as utility bills.
16. Copies of bank statements.
17. Copies of any social service benefits, such as food stamps, disability, unemployment, etc.
18. Documentation of family, social, civic, or governmental ties in Georgia which evidence intent to remain permanently.
19. If you are not a U.S. citizen, a copy of your permanent resident alien card or documentation of your current visa status.
20. Any other documentation that you may feel is relevant to your status.
Section III – To be completed by the STUDENT This is an editable PDF; Please type directly into each field.
Student name:
Student ID:
Home Phone:
Cell Phone:
Work Phone:
Email:
Present Address:
Permanent Address:
Date of Birth:
Citizenship Status:
U.S. Citizen
Resident Alien
Non-resident Alien
Term applying for waiver: Fall Spring Summer Year:
Have you established and maintained domiciled in Georgia for
at least 12 consecutive months immediately preceding the first
day of classes for the term you are requesting in-state
classification?
Yes No
What is your Georgia county of residence?
Have you ever lived in another country or in any U.S. state/territory other than the state of Georgia?
Yes No
If you have lived outside of Georgia:
When was residency established in the state of Georgia? / (mm/yyyy)
What was your reason for moving to Georgia?
Do you have a driver’s license or state-issued ID? Yes No
If yes, in what U.S. state/territory is it issued? Issue date: / / (mm/dd/yyyy)
Do you drive a vehicle? Yes No
If yes, in what U.S. state/territory is it registered? Registration date: / / (mm/dd/yyyy)
Are you registered to vote? Yes No
If yes, in what U.S. state/territory are you registered?
Did you file state income taxes for the most recent tax year? Yes No
If yes, in what state?
Did you file as a resident, nonresident or part-year resident?
Did you file federal income taxes for the most recent tax year? Yes No
List all full-time or part-time employment you have held for the past two years, including military service. List most recent employment
first. Attach additional sheets if needed.
Employer: Dates:
Address:
City: State: Zip:
Full-time or part-time:
Employer: Dates:
Address:
City: State: Zip:
Full-time or part-time:
IF YOU ARE UNDER 24, THE FOLLOWING SECTION MUST BE COMPLETED. IF YOU ARE 24 OR OLDER, SKIP TO SECTION IV.
Were claimed as dependent on the state or federal income tax
returns of your parent(s) or U.S. court-appointed legal guardian
filed for the most recent tax filing year?
Yes No
Did your parent(s) or U.S. court-appointed legal guardian provide
you with any financial support in the last year?
Yes No
If yes to either of the above questions, the following must be answered.
Has the parent or U.S. court-appointed legal guardian who claimed you as a dependent on their state or federal income tax return filed
for the most recent tax year, established and maintained domicile in Georgia for at least 12 consecutive months immediately preceding
the first day of classes for the term you are requesting in-state classification?
Yes No
If yes to the above question, the following questions in this section must be answered.
Name of your Georgia-domiciled parent or U.S. court-appointed legal guardian:
Relationship:
If the individual listed above is your U.S. court-appointed legal guardian, on what date was the guardianship appointed?
/ / (mm/dd/yyyy)
Has your parent or U.S. court-appointed legal guardian ever lived in another country or in any U.S. state/territory other than the state
of Georgia?
Yes No
If the parent or U.S. court-appointed legal guardian listed above has lived outside of Georgia:
When was residency established in the state of Georgia? / (mm/yyyy)
What was their reason for moving to Georgia?
Section IV – Basis for Request for In-State Classification
Indicate under which of the following categories you are seeking in-state classification (select all that apply):
I am a Dependent Student
My parent(s) have established and maintained domicile in Georgia for at least 12 consecutive months
immediately preceding the first day of classes for the term I am seeking in-state classification and
I have graduated or will graduate from a Georgia high school; and/or
My Georgia –domiciled parent claimed me as a dependent on their federal or state income taxes
filed for the most recent tax year.
My U.S. court-appointed legal guardian established and maintained domicile in Georgia for at least 12 consecutive
months immediately preceding the first day of classes for the term I am seeking in-state classification and I can
provide clear evidence that the appointment was not made to avoid payment of out- of-state tuition.
I was previously classified as an in-state student at another USG institution and have remained continuously
enrolled. Since I was originally classified as an in-state student, my Georgia-domiciled parent(s) or U.S. court-
appointed legal guardian has moved out of state.
I am an Independent Student
I have established and maintained domicile in Georgia for at least 12 consecutive months immediately preceding the
first day of classes for the term I am seeking in-state classification. I did not move to Georgia solely for the purpose
of attending a postsecondary institution and I was not claimed as a dependent on my parents’ most recent income tax
return.
I was previously classified as an in-state student and temporarily left Georgia for less than 12 months.
According to the U.S. Bureau of Citizenship and Immigration Services, I am a Lawful Permanent Resident, refugee, asylee or
other eligible noncitizen permitted to remain indefinitely in the United States.
Provide the following information for your Georgia-domiciled parent or U.S. court-appointed legal guardian listed above.
Do they have a driver’s license or state-issued ID? Yes No
If yes, in what U.S. state/territory is it issued? Issue date: / / (mm/dd/yyyy)
Do they drive a vehicle? Yes No
If yes, in what U.S. state/territory is it registered? Registration date: / / (mm/dd/yyyy)
Are they registered to vote? Yes No
If yes, in what U.S. state/territory are you registered?
Did they file state income taxes for the most recent tax year? Yes No
If yes, in what state?
Did you file as a resident, nonresident or part-year resident?
Did they file federal income taxes for the most recent tax year? Yes No
List all full-time or part-time employment the parent or U.S. court-appointed legal guardian listed above has held for the past two years,
including military service. List most recent employment first. Attach additional sheets if needed.
Employer: Dates:
Address:
City: State: Zip:
Full-time or part-time:
Employer: Dates:
Address:
City: State: Zip:
Full-time or part-time:
Submit completed form and the necessary documentation to:
By Mail:
Office of Academic Services and Registrar
ATTN: Tuition Classification Officer
Albany State University
Billy C. Black Building, Room 283
504 College Drive
Albany, GA 31705
By Email: tco@asurams.edu
Subject: ATTN: Tuition Classification
Officer
By Fax: 229-430-2953
ATTN: Tuition Classification Office
Section V – Oath and Affirmation
I understand that any material false statement made knowingly and willingly by me on this application, or any documents
attached hereto may, in accordance with O.C.G.A. 16-10-71, which provides that upon conviction, a person who knowingly
commits the offense of false swearing shall be punished by a fine of not more than $1,000 or by imprisonment for not less
than one nor more than five years, or both, subject me to prosecution in a court of law. Additionally, I further understand
that any such false statement may subject me to immediate dismissal from the institution.
Further, I certify that, to the best of my knowledge, the information submitted on this application is true and complete.
Student’s Signature Date
Section VI – Notary Oath and Affirmation
STATE OF __________________________________
COUNTY OF ________________________________
The foregoing instrument was acknowledged before me this _____day of _____, 20___, by ___________________________
(Individual Applying for Tuition Waiver)
Signature of Notary Public-State of ____________________
Notary Seal
Name of Notary Typed, Printed, or Stamped
Personally Known _______ OR Produced Identification _______
Type of Identification Produced
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Nonresident Students TuitionWaiver Application

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Completed 3 November 2019

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