MSU Denver Office of Admissions
Student Success Building | Counter #1
Campus Box 16 PO Box 173362
Fax Number:720-778-5794
Phone Number: 303-556-3058
msudenver.edu/admissions| admissions@msudenver.edu
Petition for In-State Tuition
Page 1 of 3
Name:
_____________________________________________________________________
Date of Birth:
____________________________
900#:
___________________________
Email:
__________________________________
Phone Number:
I affirm that I have read, understand, and agree to this form in its entirety and that the information supplied is true and complete.
Signature:
___________________________________________________
Date:
_____________________
Citizenship or Immigration Status: U.S. Citizen Permanent Resident
Asylee / Refugee
Adj
ustment Applicant Undocumented / Unclassified
Marital Status:
_____________
Date Married:
________
Maiden Name:
________________________
Mo/day/yr
What semester are you applying for In-State Tuition?
Fall Spring Summer
____________
year
This petition is used by continuing students who have attended and paid non-resident tuition during the past
three semesters, students who were emancipated prior to turning 23 years old, students who did not submit
the In-State Correction Form by the published deadline in the current term schedule, or students who were
asked by the Tuition Classification Officer at MSU Denver to complete this form. This form must be submitted
by the published deadline for determination. The deadline for the Petition for in-State Tuition is 30-days after
the first day of the semester. University published deadlines are listed on the Academic Calendar as well as the
Residency page of the website. Failure to do so will result in non-resident tuition without the right to appeal.
The Col
orado tuition law requires students to show clearly and convincingly that they qualify for in-state status. The
student is responsible to provide any information and documentation necessary for MSU Denver to determine eligibility
for in-state tuition classification. More information can be found on our website:
www.msudenver.edu/admissions/residency
.
Students must be able to prove that their Colorado domicile began no later than 12 months preceding the start of
classes for the semester that they are requesting in-state tuition classification. The University’s determination of
domicile for tuition purposes will be made on the basis of written information and supportive documentation supplied
with this Petition. Failure to include any required document or answer any question by the deadline may render the
petition invalid.
If false information or any falsified supporting document is included in this petition, the petition will be void and any
determination of in-state classification based on the Petition will be nullified. Documents become the property of MSU
Denver and will not be returned. Petitions will be digitally stored to the student’s file and all original documents will be
shredded.
Please refer to the MSU Denver website for tuition payment deadlines. Students who are classified as non-resident for
tuition purposes will be subject to the non-resident tuition and fees. The University will send status notifications on any
decision or any request for additional information to the student’s MSU Denver email.
DIRECTIONS:
Office Use Only:
Term:
Residency Status:
Approved/Denied
by
:
Date:________
Comments: ____________________________________________________________________________________
click to sign
signature
click to edit
MSU Denver Office of Admissions
Student Success Building | Counter #1
Campus Box 16 PO Box 173362
Fax Number:720-778-5794
Phone Number: 303-556-3058
msudenver.edu/admissions |admissions@msudenver.edu
Petition for In-State Tuition
Read and answer every question on this petition carefully.
Submi
tting an incomplete Petition and/or failing to provide supportive documents will delay processing.
A & B will help you determine if we need the student’s, parent’s or legal guardian’s information
for tuition classification purposes.
Provide supportive documentation.
This
may include but is not limited to proof of guardianship, emancipation, military status as well as
evidence of Colorado domicile (presence and intent) for 12 months preceding the start of classes.
Proof of Legal Guardianship:
Court Decree or Letter of Guardianship
Statement from the court that shows living birth parents do not provide substantial support
Certified statement from the court that shows this appointment is not due to tuition classification purposes
Evidence of Emancipation:
Marriage License
Individual and Parent’s Federal Income Tax (1040)
Monthly Bank Statements
Trust Account Statements
Proof of Military or Veterans
Active Duty Leave and Earnings Statement (LES)
Military Service Record for Discharged Veterans (DD-214)
Evidence of Physical Presence: Evidence of Intent:
Lease Agreement License or State Identification
Mortgage Statement Employment Offer Letter
Warranty Deed Pay Stubs
Utility Bills State Income Tax Returns
Bank Statements Voter Registration
Vehicle Registration
A. Gradua
te student:
No
(continue)
Yes
(skip to 1; complete page 3 with student’s information)
B. Student married: No (skip to C)
Yes
(continue)
Date of marriage at least 12 months preceding the start of classes:
No
(skip to 1; complete page 3 and Emancipation Determination with student’s information)
Yes
(skip to 1; complete page 3 with student’s information and provide copy of marriage license)
C. Student under the age of 23 on the day before classes begin: No (skip to 1)
Yes
(continue)
Parent or legal guardian live in Colorado:
No
(skip to 1; complete page 3 and Emancipation Determination with student’s information)
Yes
(continue)
Name of Parent or Legal Guardian:
_____________________________________________________________
Relationship to Student:
______________________________________________
(complete page 3 with parent or court-appointed legal guardian information and provide documentation)
1. List each address you have lived at and the dates you lived there for the past 12 months:
Page 2 of 3
Petition for In-State Tuition
Page 3 of 3
MSU Denver Office of Admissions
Student Success Building | Counter #1
Campus Box 16 PO Box 173362
Fax Number:720-778-5794
Phone Number: 303-556-3058
msudenver.
edu/admissions |admissions@msudenver.edu
____
To
____
Street
City
State
Zip
Date
Date
____
To
____
Street
City
State
Zip
Date
Date
2. List source of income or support for the past 12 months: (employment, government benefit,
individual assistance)
_______________________________
________________
____________
____
To
____
Source
City
State
Date
Date
_______________________________
________________
____________
____
To
____
Source
City
State
Date
Date
3. List the last two years of Colorado state income tax return:
__________
,
__________
Year
year
If you did not file in the past two-years, please state reason(s):
_____________________________
Have you filed income tax in another state?
No Yes
_____________
_____________
Year
Year
4. Do you have a current Colorado driver’s license or state identification? No Yes
5. Are you regist
ered to vote in the State of Colorado? No Yes (www.govotecolorado.com)
6. Are you an owner of a motor vehicle that is registered with the State of Colorado? No Yes
7. Did you accept empl
oyment in Colorado prior to moving here? No Yes
8. Did you serve i
n the military within the past two years? No Yes
Were you stationed in Colorado?
No Yes
Dates of service:
________
________
mm/dd/yy
mm/dd/yy
9. Graduation from a Colorado High School after attending consecutively for 3 years? No Yes
10. Attendance at a C
olorado College or University within the past 12 months? No Yes
I hereby swear/affirm that the answers given in this petition are accurate and complete, and that all the
documents, attached hereto, are true and unaltered. If my circumstances change, affecting my tuition
status, I agree to notify the Office of Admissions in writing within 15 days of such change. I understand
that I am financially and academically responsible for all classes that I will or have registered for
regardless of the outcome of this petition process.
Student:
____________________________________________________
______________________
Signature
Date
Parent/Guardian:
_____________________________________________
______________________
Signature (Only required if their information is provided)
Date
click to sign
signature
click to edit
click to sign
signature
click to edit
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome