Last First Middle Initial UA ID No.
Mailing Address
City
State Zip
Phone No.
Email Address
Birthdate
(Start Date MM/DD/YYYY)
(MM/DD/YYYY)
OPTION A Proof of Permanent Fund Dividend Eligibility
Your answer to ALL of the following criteria must be yes to qualify under option A. Documentation of State of Alaska Permanent
Fund Dividend (PFD) eligibility or receipt must be attached to this form.
I am eligible for resident tuition assessment because I:
1. Receivedorwasqualied*toreceiveanAlaskaPermanentFundDividendbytheStateofAlaskaPermanentFundDividendDivision
within the last 12 months; and
2. Can certify that I have been in Alaska for the past 12 months; and
3. DeclaremyintenttoremaininAlaskaindenitely.
In the past two years, I have NOT:
• Been absent from Alaska for an aggregate of more than 120 days other than documented absences due to illness, or attendance at
another educational institution while maintaining Alaska residency;
• Acted inconsistently with Alaska residency, such as claiming residency in another state or voting as a resident of another state;
• Registered as a resident in an educational institution in another state; or
• Paid tuition at the University of Alaska at the Western Undergraduate Exchange (WUE) program rate.
*Theterm“qualied”initem1abovereferstoanindividual’seligibilityforthePFDdistributedwithinthelast12months,eventhoughthePFDmayhavebeengarnishedor
withheld from the recipient. Proof of PFD distribution or eligibility (not just proof of PFD application) is required prior to the published end of the add/drop period for regular
semester-length courses for the semester in which residency is sought.
OPTION B Proof of Physical Presence
Your answer to ONE of the following criteria must be yes to qualify under option B, and all documentation must be attached to this
form. Note: additional information may be required to support your claim.
I am eligible for resident tuition assessment because I have been physically present in Alaska for two or more years and I am
supplying:
Documentation that I moved my household goods to Alaska prior to two years ago; or
Documentation of my lease, rental, or ownership of real property in Alaska for at least the prior two years; or
Documentation of my permanent employment in Alaska for at least the prior two years; or
OtherindiciaofAlaskaresidencyforthetwoprioryearsdeemedsatisfactorybythechiefenrollmentofcerordesignee.
In the past two years, I have NOT:
• Been absent from Alaska for an aggregate of more than 120 days, other than documented absences due to illness or attendance at
another educational institution while maintaining Alaska residency;
ActedinconsistentlywithAlaskaresidency,suchasclaimingresidencyinanotherstate,obtainingadriver’slicensefromanotherstate,or
voting as a resident of another state;
• Registered as a resident in an educational institution in another state; or
• Paid tuition at the University of Alaska at the Western Undergraduate Exchange (WUE) program rate.
Complete this form to apply for resident tuition assessment and if you plan to enroll in more than 4 credits a semester. Submit it along with
supportingdocumentationtotheappropriatecampusofcepriortothepublisheddeadlinetoaddordropregularsemester-lengthcoursesinthe
semester for which residency is sought.
P
Page of
University of Alaska
Application for Resident Tuition Assessment
Term for which resident tuition is rst requested:
Fall 20 Spring 20 Summer 20
Late Start Class Begins:
OPTION C
Exemption of Nonresident Surcharge
Your answer to ONE of the following criteria must be yes to qualify under option C, and all documentation will be required when
this form is submitted. If you enroll in 4 credits or less per semester, fees will be assessed at the resident rate. Once you enroll
in 5 or more credits, the non-resident surcharge is applied to ALL registered credits.
Unlessthecontextrequiresotherwise,“dependentchild”meansanunmarried,naturaloradoptedchild,whoisunder24
yearsofage,andwhoisnanciallydependentuponthesubjectindividualforsupportasevidencedbythemostcurrent
federalincometaxreturnledwithinthepast16months.
I am eligible for resident tuition assessment because I am:
United States military personnel on active duty, their spouse, or dependent child. (Ofce use only: Military ID veried by:
)
AUnitedStatesveteraneligibleforVeteransAdministrationeducationbenet,theirspouse,ordependentchild.
A member of the National Guard and Reservists, their spouse, or dependent child.
The dependent child of a person who graduated and holds an associate, bachelor, master or doctoral degree from the
University of Alaska.
Parent name at time of graduation:
Date of birth:
Year parent or guardian graduated from University of Alaska:
The dependent child of an Alaska resident.
A student participating in the Western Interstate Commission on Higher Education (WICHE) Western Regional Graduate Program (WRGP).
A student from another state or province whose public universities waive nonresident tuition surcharges for Alaska residents as listed in
UA Regulation 05.10.050.
City Name:
A student from a foreign city or province that has established sister city or sister province relationships with the State of Alaska, or Alaska
municipalities, and that has been appr
o
v
ed b
y the president as list
ed in UA Regulation 05.10.050.
City Name:
ThespouseordependentchildofaUniversityofAlaskaemployeeinabenet-eligibleposition.(Ofce use only: veried by:
)
Employee name: Employee ID:
Astudentwhograduatedwithinthepast12monthsfromaqualiedAlaskahighschool.
TobeconsideredaqualiedhighschoolforthepurposesofUAresidencytuitionassessment,ahighschoolmustbelocatedinthe
State of Alaska, issue a diploma recognized by the Alaska Department of Education, and:
• be a public high school listed in the current State of Alaska Department of Education directory; or
• be accredited by the Northwest Association of Accredited Schools; or
• be a private school properly registered with the State of Alaska Department of Education.
Listed on an active college savings plan account with Alaska 529, T. Rowe Price College Savings Plan, or John Hancock Freedom 529
Plan and have held the account for a minimum of two years prior to the current semester.
ThechildorlinealdescendantofacurrentAlaskaresidentasdetailedunderComeHometoAlaska(AcademicYears2014-2019 only).
Tobeeligible,studentsmustprovelinealdescentfromacurrentAlaskaresidentthroughbirthcerticatesorothervitalrecords.
Student must move to and reside in Alaska, and remain continuously enrolled during their course of study.
IamaUnitedStatescitizenoreligiblenoncitizenand(exceptoptionC)IamdeclaringmyintenttoremaininAlaskaindefinitely.By submitting this
application, I certify that I am or will be an Alaska resident for tuition purposes, or that I qualify for the nonresident surcharge exemption, as defined in
BOR Policy P05.10.025 or P05.10.050.Iunderstandthatfailuretofilethisformpriortothe published deadline, in the semester for which residency is
sought, will waive any claim for resident tuition assessment in that semester or prior semesters.ApplicantswithpriordocumentedAlaskaresidencywill
begranteda60-dayextensiontotheabove
stateddeadlinetoprovere-establishmentof their residency.
Ofce use only
Approved Denied By: Date:
Residency pending for the following documentation:
Initials: Date: Term: Fall 20 Spring 20 Summer 20 Late start (date)
Signed: Date:
University of Alaska Anchorage
Enrollment Services
3211 Providence Drive
University Center #106
Anchorage, AK 99508
Phone: (907) 786-1480
Fax: (907) 786-4888
uaaresidency@alaska.edu
Kenai Peninsula College
Student Services
156CollegeRoad
Soldotna,AK99669
Phone:(907)262-0330
Fax:(907)262-0322
iyinfo@kpc.alaska.edu
Kodiak College
Student Services
117BennyBensonDrive
Kodiak,AK99615
Phone:(907-486-1266
Fax:(907)486-1264
studentservices@kodiak.alaska.edu
Mat-Su College
Student Services
8295 E. College Dr.
Palmer, AK 99645
Phone: (907) 745-9746
Fax: (907) 745-9747
uaa_mscinfo@alaska.edu
University of Alaska Fairbanks
OfficeofAdmissions
P.O.Box757480
Fairbanks,AK99775
Phone:(907)474-7500
TollFree:1(800)478-1UAF
uaf-admissions@alaska.edu
2nd floorSigners’Hall
University of Alaska Southeast
OfficeofAdmissions&Registrar
11066 Auke Lake Way
Juneau,AK99801
Phone:(907)796-6100
TollFree:1(877)465-4827
Fax:(907)796-6365
uas.registrar@alaska.edu
08/2017
Page of
UA is an AA/EO employer and educational institution and prohibits illegal discrimination against any individual: www.alaska.edu/nondiscrimination.
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