Fill - Free fillable Office of the Registrar - Division of Student (LaGuardia Community College) PDF form

Revised

by: TL-12/16/ 2020

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Office of the Registrar - Division of Student Affairs

INSTRUCTIONS FOR COMPLETION OF APPLICATION FOR NEW YORK CITY

RESIDENT TUITION

To qualify for CUNY New York City tuition rates, students must prove one (1) year of residency

in New York City prior to the first day of classes and must not be on a temporary visa. Students

must be U.S. citizens, permanent residents, refugee/asylum granted (I-94 card) to qualify for NYC

tuition rate.

To apply for New York State residency status for tuition billing purposes:

Please visit the College web site at www.laguardia.edu/registrar. On the left menu, click on

“forms (download)”. Residency forms are listed on the center menu. Please download the

residency application, copy any supporting documentation requested and return the completed

application in person or by mail to:

LaGuardia Community College

29-10 Thomson Avenue, Room C-107

Long Island City, NY 11101

Residency forms will be not be accepted after the end of the semester (last day of final exams)

for which the student is applying for a residency determination.

Residential Rate of Tuition for Undocumented or Out-of-Status Students:

A law provides in-state (resident) tuition benefits to certain undocumented students. You may

qualify for the lower in-state tuition if you meet one of the following eligibility criteria:

You attended an approved New York State High School for two years and graduated from

an approved New York State high school and attend CUNY within 5 years of receiving a

New York State High School diploma

OR…

You attended an approved New York State program for General Equivalency Diploma

(GED) exam preparation, received a GED issued within New York State, and attend CUNY

within 5 years of receiving a New York State General Equivalency Diploma;

Please file the Residency form Part A: CUNY Application and Part B: Affidavit of Intent to

Legalize Immigration Status available from the web site.

If you were enrolled in CUNY in the Fall 2001 semester or quarter and were authorized by CUNY

to pay tuition at the resident rate, please submit Part A: CUNY Application only so we may

verify your resident tuition status.

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Office of the Registrar - Division of Student Affairs

INSTRUCTIONS FOR COMPLETION OF APPLICATION FOR NEW YORK CITY

RESIDENT TUITION (Continued)

Living outside the 5 Boroughs of

New York City:

If you live in New York State but outside the five (5) boroughs of New York City

(Bronx, Manhattan, Queens, Brooklyn and Staten Island), you will need to visit the County Clerk’s

office where you reside to obtain a B-81: Certificate of Residency Form and present it to the

Bursar’s Office in Room C-110. The B-81 form is good for 1 calendar year. The Bursar’s Office

will place a Stop on student registrations that have expired B-81 forms on file.

Residency Appeals:

If you wish to appeal, you must notify the Registrar’s Office in which you submitted your

application to in writing within 10 days of being notified that you have been determined to be a

non-resident. Your statement should indicate why you disagree with the decision and should be

placed in a sealed envelope with your name on it. The Registrar’s Office will submit the Residency

Form, copies of all documentation provided by you and any statement made by you, along with the

determination made by the College, to the University Office of the Vice Chancellor for Legal

Affairs and General Counsel.

Need Help?

If you have any questions about completing your application, please contact Ms. Carmen Marte by

email at cmarte@lagcc.cuny.edu, by phone at (718) 482-5051 or visit the Enrollment Services

Center, Rm. C-107 Mon &Thurs., 9:00am – 7:00pm. Tues & Wed.,9:00am-5:00pm. Fridays

9:00am-1:00pm.

Revised

by: TL-12/16/ 2020

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Column A

• Lease, deed or rent registration form (used for

rent stabilized apartments) signed by the

landlord which is either a public or private

agency and the student or parent of the student

with the same surname,

• Budget/benefit letter from New York City

Public Assistance with the student’s New York

address covering the

12 months period

immediately preceding the first day of classes

and

including the student’s name.

• Benefit letter from Social Security with the

student’s New York address covering the 12

month period immediately preceding the fi

rst

day of classes incl

uding the student’s name.

• Copies of the most recent complete Federal or

New York State tax returns with the preprinted

address label and the correspondi

ng W-2 form

Column B

• A valid New York State driver’s license showing the date of

issuance one year prior to the first day of classes,

• Homeowner’s or renter’s insurance policy,

• Automobile registration,

• Automobile insurance certificate,

• Voter Registration certificate or card,

• New York State “non-license” which is issued to non-drivers(for

identification purposes) by the Department

of Motor Vehicles or

other official City, State or Federal agencies, certificate or card,

• Telephone or utility bills or payment for services such as cable

TV covering a period of

up to 12 months,

• Monthly bank or credit card statements covering a period of 12

months (dollar amounts may be blocked out),

• Armed forces identification card DD form 2A (green),

• Attendance as a juror in New York State,

• Lease signed by the landlord (who is an individual and is not

public or private agency) and the student. If the student’s name

does not appear on the lease, an “Alternate Lease Statement” must

be completed and notarized by both the person whose name

appears on the lease/contract and the student. The person whose

name appears on the lease/contract must submit proof (i.e., lease,

telephone, utility or similar type bills) of residency at his/her

current address for the previous 12 months.

• Copies of the most recent complete Federal or New York State

tax returns without the preprinted address label and the

corresponding W-2 form

. Responses to Federal form 4506 and

New York state form 4506 requesting Federal and State tax

information is acceptable if the Federal and State governments

acknowledge that the party in question has in fact filed a tax

return from the address noted,

• Postmarked mail addressed to a student at a New York address

more than 12 months immediately preceding the first day of

classes (a P.O. Box is not acceptable)

Office of the Registrar - Division of Student Affairs

INSTRUCTIONS

Required Documentation Which Must Accompany the Residency Form

In addition to completing the residency form, students must submit required forms listed below as proof

of residency. Important Note: In addition to the items indicated below, the college may, at its discretion,

require the student to submit additional documentation if it believes that further proof is necessary in

order that an accurate residency determination may be rendered.

YOU MUST SUBMIT EITHER:

ONE of the forms listed below in Column A O

TWO forms listed below in Column B

Revised by: TL-12/16/ 2

020

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Office of the Registrar - Division of Student Affairs

ELIGIBLE VISA TYPES

The following is a list of the categories of non-immigrant aliens who under Federal law have the

capacity to become City and State of New York domiciliaries and therefore may qualify for the

resident rate of tuition provided they have established intent and also satisfy the University’s

residency requirements.

Status Description

A Ambassadors, diplomats and certain other foreign officials and their

families.

E Treaty trader/Treaty investor, spouse, and children.

G Certain government or international organization officials and their

families.

H-1B Temporary worker in specialty occupation.

H-1C Temporary worker performing professional nursing services.

H-4 Spouse or children of alien classified as H-1B or H-1C.

I Representatives of foreign information media and their spouse and

children.

K Fiancé(e) or Spouse of a U.S. citizen and dependent children.

L Intra-company transferee (such as managers who have worked abroad

for a branch of a U.S. firm) and their spouse and children.

N Parents and children of an alien granted permanent residency as a

special immigrant.

R Religious workers and their spouse and children.

S Crime witnesses and their spouse and children.

T Victims of alien trafficking.

U Crime Victims.

V Spouse and children of a permanent resident who have a relative

petition or an adjustment of status application pending for more than

3 years

Revised b

y: TL-12/16/ 2020

CITY UNIVERSITY RESIDENCY FORM

CUNY RESIDENCY FORM: Part A

1. Last Name __________________________ First Name _______________ Middle Initial _______

2. CUNYfirst ID/Student ID _____________________ Date of Birth ________________________

Phone No.( ) _____________ Email address: ____________________________________

3. Are you a U.S. citizen? Yes  No  Are you a permanent resident alien? Yes  No 

Are you here on a visa? Yes  No  Visa type: _______ Expiration Date: ______________

4. Did you attend a New York State high school for two or more years, and graduate from that high

school?

Yes  No  If yes, high school name and address __________________________________

Date of Attendance From: _________ To: _________ Graduation Date _____________________

5. Do you have a GED/TASC issued by NYS? Yes  No  Date Issued:_________________

6. If you answered “yes” to item 4 or 5, did you apply to CUNY within 5 years of your high school

graduation or receiving a GED/TASC? Yes  No  Date of first application to CUNY: ________

7. Are you a veteran or other individual eligible for educational assistance under federal GI bills?

Yes _____No ____ If yes, attach supporting documents.

IMPORTANT: If you answered “yes” to question 4 or 5, and to question 6, and are not lawfully present in the US, you

need to complete Section B (affidavit) of this Residency Form but not Section C. If you answered “yes” to question 4 or

5, and to question 6, and are a resident of another state, you do not need to complete any other sections of this form. If

you answered “yes” to question 7, you do not need to complete any other sections of this form. All other students must

complete Part C of this form and submit appropriate supporting documentation.

Please note that some students who are here on visas may not be eligible for the resident tuition rate. Please refer to

the CUNY Tuition and Fee Manual (see link below) for a comprehensive list of eligible visa types.

To Be Completed by All Students

I certify that all information provided and all statements made in all sections of this Residency Form are true and correct

to the best of my knowledge.

I understand that if I provide false information or withhold relevant information in order to obtain resident status, The City

University may revoke its determination of in-state residency, and that I will owe non-resident tuition to the University for

each semester or session that I have attended under these circumstances. I also understand that I may be subject to

disciplinary action.

DATE _______________________ STUDENT SIGNATURE ________________________________

 The colleges will not review any residency determination unless the request for the review is made in writing, and all

required documentation is submitted on or before the last day of finals in the semester for which resident tuition is

being sought.

 Complete rules regarding eligibility for the resident tuition rate and appeals procedure are set forth in CUNY’s Tuition

and Fee Manual at http://www.cuny.edu/about/administration/offices/la/tuition-fee-manual.html

Semester: ____________

Choose One

CUNY RESIDENCY FORM: Part B

Affidavit of Intent to Legalize Immigration Status

_____________________________, being duly sworn, deposes and says that he/she does not currently

(Student’s Name)

have lawful immigration status but, has filed an application to legalize his/her immigration status or will file

such an application as soon as he/she is eligible to do so.

__________________________________

(Student’s Signature)

Sworn to me this _________________day of the month of _______________ ,20___

______________________, State of New York, County of _____________________.

CUNY RESIDENCY FORM: Part C

1. Last Name ____________________________ First Name _______________ Middle Initial ______

2. CUNYfirst ID/Student ID______________ Email: ________________________________________

3. Current Address ______________________________ ________________ ________ _________

STREET CITY STATE ZIP

A. Live with parents _________, or other relatives _________, or other than a relative ___________

1) If other relatives, describe relationship. ______________________________________________

2) If other than a relative, describe situation. ___________________________________________

_____________________________________________________________________________

List below all your addresses, including temporary addresses and summer addresses during the past 12

months, starting from your current address and working backwards.

FROM TO COMPLETE ADDRESS

____________________________________________

STREET

____________________________________________

CITY STATE ZIP

____________________________________________

STREET

____________________________________________

CITY STATE ZIP

____________________________________________

STREET

____________________________________________

CITY STATE ZIP

4. A. Parents' permanent address _____________________________________________________

STREET

_____________________________________________________

CITY STATE ZIP

B. If you are under the age of 18, does anyone other than your parents serve as your legal

guardian? Yes____ No_____

If yes, what is their name and address? ____________________________________________

____________________________________________________________________________

C. Where did you live during the last June through August period? If different from 4.A., give

reason for being elsewhere during period

____________________________________________________________________________

Semester: ____________

Mo __ Day __ Yr __

__ Day __ Yr __

Mo __ Day __ Yr __

o __ Day __ Yr __

Mo __ Day __ Yr __

Choose One

- page 2 of Part C-

5. A. Please list below all full-time and part-time employment (including summer employment and

voluntary activities) during the past 12 months starting with the most recent employment.

EMPLOYER ADDRESS (CITY/STATE) FROM TO

_______________________ ___________________________ __________ _________

B. What is the source of your support?_________________________________________________

C. Did you file a New York City/State resident income tax return during the past 12 months? ______

D. Did you file a Federal income tax return during the past 12 months? ______________________

6. What are your purposes for residing in New York City or New York State?_____________________

7. Have you applied for any financial aid, scholarships, or other benefits provided under the laws of

the State of New York or the United States? Yes _____ No _____

If yes, specify and indicate what benefits you are receiving. __________________________________

__________________________________________________________________________________

8. At the present time is it your intention to permanently live in New York City or New York State?

Yes _____ No _____ Uncertain _____ If uncertain, please explain. __________________

__________________________________________________________________________________

9. Do you have any other proof other than the items indicated for completing the Residency Form that

you wish to present in support of your application to be declared a resident of New York City/New

York State for the City University of New York tuition purposes? Yes _____ No ____

If yes, please provide details and attach relevant documents.

__________________________________________________________________________________

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ALTERNATE LEASE STATEMENT

Name:____________________________ ________________________

Semester: _____________

Last Name

Fist Name

Phone №

_________________

UNYfirst Empl ID# ____________________

Current Mailing Address:

___________________________________________ _______ ___________________ ______ ________

Apt № City

State Zip Code

Street

Year

Month

I have lived at the above address from

______ /________

Month

to ______ /________

_______________________________________

Date: ____________

Signature

NOTARIZED

Office of the Registrar - Division of Student Affairs

Year

____

___

____

___

________________

Date: ____________

Signature

NOTARIZED

______________________________________________________________________________________

I certify that the above information is accurate and complete. I understand that this information

may affect my residency status at the college. I understand that if I provide false information or

withhold relevant information in order to obtain resident status, The City University may revoke its

determination of in-state residency, and that I will owe non-resident tuition to the University for

each semester or session that I have attended un

der these circumstances. I also understand that I

may be subject to disciplinary action.

But the lease is NOT in my name.

_______________________________________________________________________________________

TO BE COMPLETED BY THE PERSON WHOSE NAME APPEARS ON THE LEASE/CONTRACT.

___________________________________certify that I reside at the address indicated above and that

Owner/Leasee's Name

_____________________________________ has resided with me from _____/_____ to _____/_____

Student's Name Month/Year Month/Year

Proof that I have resided at the above address for one year is attached (e.g.: lease, telephone bill,

utility bill, apartment or house insurance, or mortgage statement).

Revised by: TL-12/16/ 2020

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