Phil Campbell Campus – 2080 College Road – Phil Campbell, AL 35581 – (256)331-6219/6227 – Fax (256)331-6292
Shoals Campus – P.O. Box 2545 – Muscle Shoals, AL 35662 – (256)331-5425/5461 – Fax (256)331-5366
Rev. 07/2019
NORTHWEST-SHOALS COMMUNITY COLLEGE
THE ALABAMA COMMUNITY COLLEGE SYSTEM
PETITION FOR IN-STATE TUITION
Student Name: ______________________________________________________ SIN: _______________________________
Address: ________________________________________________________________________________________________
Home Phone: ___________________ Cell Phone: _____________________ Date of Birth: ________________________
Semester: _______________________________________________ Number of hours enrolled: _______________________
I submit this application for in-state residency for tuition purposes based on one of the following:
I (or my non-estranged spouse) have lived in the State of Alabama for at least 12 months.
I am a minor, and my parent(s)/legal guardian(s) has lived in the State of Alabama for at least 12 months.
I hereby certify that the above address is my residence in the State of Alabama, and I intend to remain at this address indefinitely. I
further certify that I have more substantial connections with the State of Alabama than with any other state.*
I am a non-resident dependent student, and my supporting person is a full-time permanent employee of this institution.
I am a non-resident dependent student, and my supporting person can verify full-time permanent employment in Alabama, a
nd
s
aid employment will begin within ninety (90) days of my registration.
I am a non-resident dependent student, and my supporting person is a member of the United States military on full-time active
duty stationed in Alabama under orders for duties other than attending school.
I am a non-resident dependent student, and my supporting person is an accredited member of a consular staff assigned to duties i
n
A
labama.
I (or my spouse) am a full-time permanent employee of this institution.
I (or my spouse) can verify full-time permanent employment in Alabama, and said employment will begin within ninety (90) days of
my registration.
I (or my spouse) am a member of the United States military on full-time active duty stationed in Alabama under orders for duties
other than attending school.
I (or my spouse) am an accredited member of a consular staff assigned to duties in Alabama.
I reside in a county of a state which is within the 50-mile radius of the designated campus of this institution.
I understand that in order to be eligible for resident tuition rates, the burden of proof lies with me. Appropriate documentation is
attached in support of my request for eligibility for resident tuition rates. I agree to notify the college if there are any changes in the
information submitted with this form. I understand than an out-of-state student cannot attain resident student status simply by
attending school for 12 months in the State of Alabama.
Signature of Student: ________________________________________________________ Date: __________________________
*The following connections will be considered by the college in determining eligibility for resident tuition rates. (Check categories where
documentation has been provided.)
Location of high school graduation
Payment of Alabama state income tax as a resident
Ownership of a residence or other real property in the state
and payment of state ad valorem taxes on the residence or
property
Full-time employment in the state
In-state residence of a spouse, parents, or children
Previous periods of residency in the state for one year or
more
Voter registration and voting in the state (preferably initially
occurring at least one year prior to the initial registration of
the student in Alabama)
Possession of state or local licenses to do business or
practice a profession in the state
Ownership of personal property in the state, payment of
state taxes on the property, and possession of state license
plates
Continuous physical presence in the state for a purpos
e
other than attending school, excluding temporary absences
for travel, military service, and temporary employment
Membership in religious, professional, business, civic, or
social organizations in the state
Maintenance in the state of checking and savings accounts,
safe deposit boxes, or investment accounts
In-state address shown on selective service registration,
driver’s license, automobile title registration, hunting and
fishing licenses, insurance policies, stock and bon
d
r
egistrations, last will and testament, annuities, or
retirements plans.
