Fill - Free fillable Petition for In-State Tuition Classification Checklist (Front Range Community College) PDF form

Petition for In-State Tuition Classification Checklist

The Colorado Tuition Classification Statute (C.R.S. 23-7-101 et. Seq.) may be obtained at http://highered.Colorado.gov/finance/residency

The deadline to submit a complete petition, along with all documentation that you have obtained in the state of Colorado, is within 30 days of

your first day of class. It is your responsibility to pay for your classes based on non-resident tuition rates, pending a decision regarding your

residency status. Documentation submitted must be photocopies because the entire petition and supporting documentation become part of

your permanent college record. If emailed, petition and documentation must be sent as one complete file. Communication and decisions will be

sent to your student-assigned CCCS email account in eWOLF.

 Students over 23 - Complete the petition and provide ALL documentation under the

Domicile

and

Intent

areas below.

 Students under 23 whose parents or legal court appointed guardians are Colorado residents - Complete the petition and provide

Domicile

and

Intent

documentation for your biological parents or legal court-appointed guardian. If you have a legal court-appointed

guardian you must provide court documents.

 Students under 23 who are financially independent and want to prove emancipation - Complete the petition and provide ALL

documentation you have received in the state of Colorado under the

Domicile

Intent

and

Emancipation

areas below.

 Students under 23 who have been married for over one year - Complete the petition and provide ALL documentation under the

Domicile

and

Intent

areas below. Also provide a copy of your marriage certificate.

Provide ALL of the following required documentation that you have received in the state of Colorado. A decision will be

made based on the documentation provided. If you do not have something listed here, please explain.

DOMICILE DOCUMENTATION:

 Copy of your lease(s) to cover 12 months prior to the start of the semester of which you are petitioning for residency. Homeowners should

include a copy of a warranty deed. If you are not on a lease and live with a friend or relative, you must provide a notarized statement from that

person indicating the property address, dates you lived with him/her, a copy of their lease, warranty deed, or property taxes, covering the

period of time they are stating you lived with them.

2. INTENT DOCUMENTATION (submit copies of ALL that you have obtained in the state of Colorado):

 Signed copy of the most current years Colorado Income Tax Returns (based on school year)

 Copy of Voter Registration

 Copy of Driver’s License or Identification Card issued by the State of Colorado

 Copy of Motor Vehicle Registration for the past 2 years

 Verification of Employment - letter from employer(s) verifying your employment dates, or copies of paystubs for the 12

consecutive months prior to the start of the semester of which you are petitioning for residency.

 Visa, PR card or other USCIS documentation (if applicable)



EMANCIPATION DOCUMENTATION (students who are under the age of 23 whose parents do not live in Colorado who would like to

prove financial emancipation, submit ALL required documentation):

 Emancipation form (included in this packet) completed and signed by parents, and notarized

 Copy of both parents’ or legal court appointed guardians’ Federal Income Tax Returns for the most current year/school year

 Copies of your Paystubs from all employers for 12 months prior to the start of the semester of which you are petitioning for residency

 Copy of your Federal and State Income Tax Returns and W-2s for the most current year/school year

 Copies of all financial account bank statements for 12 months prior to the start of the semester of which you are petitioning for residency

(checking, savings, investments, trust accounts, etc.)

COLORADO HIGH SCHOOL RULE

**:



Students who have attended at least 3 years and graduated from a Colorado high school, and applied or attended a Colorado college

within 12 months of graduating high school:

 Copy of your High School transcript

(must have your final date of graduation on it)

 Copy of your admissions letter to a Colorado college or unofficial Colorado college transcript

**If you meet this Colorado high school rule requirement, simply attach a copy of the two documents listed above, complete the top half of the

next page, sign the petition on page 5 and submit. You do not need to go any further or provide additional documentation.

B-S-ADMN Update by the Office of the Registrar 08.01.2016

Petition for In-State Tuition Classification

Student Name (last, first, middle):

Student ID: Student Email Address: @student.cccs.edu

Street Address (with Apt. Number), City, State, and Zip:

Age: Year of birth: Local Phone:

Marital Status: Date Married: Maiden Name:

Indicate which campus you plan on attending: ☐ Boulder County ☐ Larimer ☐ Westminster/Brighton ☐ Online

Indicate semester and year for which you are petitioning (spring, summer or fall, and year):

First Semester and year at FRCC (spring, summer or fall, and year):

If the student is under 23 as of the deadline for filing this petition and is not emancipated, or if the student has turned 22 during the 12 months

before the qualifying date and was not previously emancipated, the parent or court-appointed guardian of the student, rather than the student,

must answer the questions on this petition and complete the section below. If a parent or court- appointed legal guardian completes this

petition, then the information provided must pertain to the parent or court-appointed legal guardian rather than the student.

Name of person completing form: Relationship:

Address:

Street Address (with Apt. Number)

City State Zip

Local Phone

If you are the court-appointed legal guardian of the student, you must enclose: (1) a copy of the court decree and (2) a statement from the court

that appointed you guardian certifying that the primary purpose of such appointment is not to qualify the student as an in-state resident for

tuition purposes.

YES NO

1. Have you graduated or will you graduate from a Colorado high school? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

*If yes, please see coversheet information for qualifying under Colorado high school rule.

2. Are you a citizen of the United States?. . . . …. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . .

If not, do you hold a visa or other document issued by the United States Citizenship and

Immigration Services (USCIS)? . . . . . . . . . . . . . . . . . . . . . . . . . . ……………………………………………………..

If yes, please

attach

a copy of these documents:

Copy of Visa, Copy of Permanent Resident Card, copy of USCIS documents or receipts.

3. List all specific dates of physical presence in Colorado and

attach

proof of your presence in Colorado for the past 12 months

(warranty deed, lease agreement, canceled rent checks or notarized letters from landlords)

FROM (Month, day, year):

/ /

TO (Month, day, year):

4. List all extended absences from Colorado.

FROM (Month, day, year):

/ /

TO (Month, day, year):

B-S-ADMN 1 Update by the Office of the Registrar 08.01.2016

YES NO

5. Did you file a Colorado State income tax return as a resident in the past 12 months? . . . . . . . . . . . . . . . . . . . .

a. List which years you have filed Colorado returns as a Colorado Resident:

b. List which years you have filed returns in another state:

c. If you did not file a Colorado return in the past 12 months, state reason(s):

d. Is Colorado income tax currently being withheld?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Attach

signed copies of Colorado (not Federal) income tax returns for the past 2 years. Submit W-2 forms if Colorado returns were

not filed for the past 2 years.

6. List employment for past 2 years.

Attach

a statement from Colorado employers on letterhead during the past year indicating dates

of employment, whether you were hired on a permanent or temporary basis, and whether it was/is full-time or part-time.

a. Employer (Company Name):

Address of Employer:

Dates of Employment:

FROM (Month, day, year):

/ /

TO (Month, day, year):

b. Employer (Company Name):

Address of Employer:

Dates of Employment:

FROM (Month, day, year):

/ /

TO (Month, day, year):

c. Employer (Company Name):

Address of Employer:

Dates of Employment:

FROM (Month, day, year):

/ /

TO (Month, day, year):

d. Employer (Company Name):

Address of Employer:

Dates of Employment:

FROM (Month, day, year):

/ /

TO (Month, day, year):

(**Submit separate sheet if listing more employers**)

7. Have you accepted future employment in Colorado? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

a. Effective date of future employment (Month, day, year):

Attach

a copy of contract or other proof on company letterhead and notarized statement.

8. Are you registered to vote? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

a. In what state? Date of registration (Month, day, year):

b. If registered in Colorado,

attach

a copy of voter registration from County Clerk.

B-S-ADMN 2 Update by the Office of the Registrar 08.01.2016

8. Have you operated a motor vehicle within the past 12 months? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

a. In what state is/was the vehicle registered?

b. If registered in Colorado, date of registration (Month, day, year):

Attach

copies of all Colorado vehicle registration showing the exact dates of registration for the last

2 years.

YES NO

NOTE: If you do not currently own a motor vehicle, but have owned one which was registered in Colorado in the past 2 years,

attach

copies of these registrations or proof from the Motor Vehicle Office.

9. Do you have a current Driver’s license or a State I.D.? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

a. In what state was it issued? Issue date (Month, day, year):

Attach

a copy of your Driver’s license or State I.D.

NOTE: If license was re-issued in Colorado during the past 12 months, also

attach

copy of your previous license or proof from

the Motor Vehicle Office.

10. Do you own residential property in Colorado? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

a. Date Purchased (Month, day, year):

b. Address (Street/Apartment number, city, state, zip):

11. Do you maintain a home(s) in another state? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

a. List state(s):

b. List dates that you have resided in this home(s):

FROM (Month, day, year):

/ /

TO (Month, day, year):

FROM (Month, day, year):

/ /

TO (Month, day, year):

12. Have you attended any college or university during the past 2 years? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

a. List Institution Names: Dates attended (month/year):

From To

b. At which school(s) were you assessed in-state tuition?

B-S-ADMN 3 Update by the Office of the Registrar 08.01.2016

YES NO

13. Have you served in the Armed Forces during the past 2 years? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

a. List dates of service:

FROM (Month, day, year):

/ /

TO (Month, day, year):

b. During what period of this time were you stationed in Colorado?

FROM (Month, day, year):

/ /

TO (Month, day, year):

Attach

a copy of your most recent W-4 form filed with your military personnel office, a recent leave earning

statement (LES), a copy of DD-2058, and a copy of DD-214 if discharged.

14. Supply any additional information you believe may help show your intent to make Colorado your permanent home: (

attach

separate sheet if

necessary).

B-S-ADMN 4 Update by the Office of the Registrar 08.01.2016

15. College Opportunity Fund Stipend Sign Up and Authorization:

As a resident student, you are eligible to receive a College Opportunity Fund (COF) stipend to pay the state’s portion of the total cost of

education. In order to receive the stipend, you must sign up for COF. You can do this by going to the Front Range Community College

website, and under Paying for College, go to Tuition Discount Programs, and then College Opportunity Fund. There you will find a link

to complete the sign up process, or go to www.frontrange.edu/cof. You are also asked to authorize the use of the stipend each

semester when you first register for classes. If you have already registered for classes for the semester for which you are petitioning for

residency, please complete the information below. If your residency petition is approved, your authorization will be entered and you

will be eligible for the stipend, or you may choose to decline these funds.

, student ID agree to:

Authorize the use of my College Opportunity Fund stipend for the semester.

Decline the use of my College Opportunity Fund stipend for the semester.

Affirmation:

I hereby swear/affirm that the answers given in this petition are accurate and complete, and that all documents attached hereto are true and

unaltered copies of the original documents requested. If my circumstances change, affecting the tuition status requested by this petition, I

agree to notify the Office of the Registrar in writing with 15 days after such change. I also understand that I am financially and academically

responsible for all classes that I will or have register(ed) for regardless of the outcome of this petition process.

Signature of Petitioner: Date:

Signature of Parent/Legal Guardian completing this form: Date:

B-S-ADMN 5 Update by the Office of the Registrar 08.01.2016

16. List all financial support provided to you by either of your parents or legal guardians during the past 12 months:

Month Year Amount

a. Indicate the last year either of your parents or legal guardians claimed you as a dependent on their Federal tax return:

b. List both of your parents’ or legal guardians’ home address and the dates you resided there in the past 2 years.

Address _

From To

17. List all of your sources of income (employment, loans, school sources, personal savings, trust funds and gifts from relatives,

friends, etc.) since your parents/legal guardian ceased providing financial support.

NOTE: You must

attach

proof and documentation for each income source in the past 12 months.

Attach

a separate sheet for any

additional Sources of Income.

1. If your income is provided by a trust fund, furnish written documentation (such as copies of legal papers setting up the trust) of

the purpose for which the fund was formed, date it was established, and dates, amounts and persons by whom any money was

added to the trust fund in the past 12 months.

2. If you have checking and savings,

attach

documentation of monthly statements covering the entire 12-month period.

3. If employment is an income source, list it in terms of yearly take-home totals (as documented by W-2 forms, statements from

employers, etc.) NOT in terms of wages per hour, per week or per month.

Source Address

Month Day

Year

Amount per year

Source Address

Month Day

Year

Amount per year

Source Address

Month Day

Year

Amount per year

TOTAL INCOME FOR YEAR $

18. List and calculate expenses for the last 12 months:

Housing per month Total for year $

Food per month Total for year $

Tuition/fees per term Total for year $

Other per month Total for year $

(“Other” expenses include auto payments, medical bills, entertainment, etc.)

YEAR GRAND TOTAL EXPENSES $

TOTAL INCOME LESS EXPENSES $

If you are under 23 and are petitioning with your own information, please answer the following

questions and supply all documentation.

B-S-ADMN 6 Update by the Office of the Registrar 08.01.2016

Parent(s)/Legal Guardian(s) Statement

for Minor Claiming Emancipation

I/We , the parent(s)/step-

parent(s)/legal guardian(s) of (MINOR’S NAME) ,

hereby swear/affirm that I/we have entirely surrendered the right to care, custody, and earning of (MINOR’S NAME) ,

as of (month/day/year)

/ /

• When was the last time this minor was claimed by the parent(s)/step-parent(s)/legal guardian(s) on state or federal income taxes?

(month/day/year)

/ _/ .

• When was the last time this minor was carried on any medical insurance by the parent(s)/step-parent(s)/legal guardian(s)?

(month/day/year) / _/ .

• When was the last time this minor was carried on any motor vehicle insurance by the parent(s)/step-parent(s)/legal guardian(s)?

(month/day/year) / _/ .

• The only support I/we have provided to this minor has been:

The emancipation referred to herein is an absolute emancipation for all purposes whatsoever and was not done for the purpose of

tuition classification.

IMPORTANT: SIGNATURE(S) OF BOTH (IF APPLICABLE) PARENT(S)/STEP-PARENT(S)/LEGAL GUARDIAN(S) MUST BE

INCLUDED AND NOTARIZED

Signature of Parent 1: Date:

Signature of Parent 2: Date:

State of ( )

County of ( )

Sworn to and subscribed before me this

Day of , 20

Signature of Notary Public

My Commission Expires (SEAL)

NOTE: IF UPON PERIODIC RE-EXAMINATION OF AN INDIVIDUAL’S STATUS AS AN EMANCIPATED MINOR, IT APPEARS THAT THE STUDENT IS NO LONGER

EMANCIPATED, THE STUDENT IS SUBJECT TO BEING RECLASSIFIED AS AN OUT-OF-STATE RESIDENT FOR TUITION PURPOSES. EVIDENCE THAT A MINOR IS

NO LONGER EMANCIPATED MAY INCLUDE SUPPORT BY PARENT(S) OR BEING CLAIMED AS A TAX EXEMPTION BY PARENT(S)

Attached are copies of all federal income tax returns (not W-2 forms) covering the above period of emancipation.

B-S-ADMN 7 Update by the Office of the Registrar 08.01.2016

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