Fillable Petition for InState Status (Northeastern Oklahoma A&M College)

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Petition for InState Status (Northeastern Oklahoma A&M College)

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Submit to:
Admissions and Registrar’s Office
Library Administration Building Room 109
PO Box 3843, Miami, OK 74354
Phone: 918‐540‐6210 Fax: 918‐542‐9759
Petition for In‐State Status
INSTRUCTIONS:
1. Answer all questions on pages 1 through 4 of this form, and attach supporting documentation as indicated in Section 2 of
this form. All documentation is subject to verification.
2. Submit this completed form and all supporting documentation to the Office of Admissions. It is recommended that all
documentation is submitte
d before the first day for the semester. Deadlines for submitting documentation related to in‐
state reclassification in a given semester are as follows:
Fall – October 31
Spring – March 31
Summer – June 30
3. Please allow 2‐3 weeks for processing and evaluation of your petition. Failure to include all supporti
ng documentation will
delay processing.
Section 1 – STUDENT IDENTIFICATION
Student’s Name (Last, First, Middle)
Stud
ent ID Number
Term for Request
Permanent Address (Street, City, State, & Zip)
Years at this Address
Current Address (Street, City, State, & Zip)
Years at this Address
Date Arrived in Oklahoma Conta
ct Phone Number
Are you a US Citizen?
If no, are you a permanent
Date VISA issued? PLEASE ATTACH A PHOTOCOPY
resident of the US?
OF YOUR VISA (FRONT AND
Yes No
Yes No
BACK
)
Section 2 – RECLASSIFICATION RATIONALE
RECLASSIFICATION RATIONALE DESCRIPTION SUGGESTED SUPPORTING DOCUMENTATION
A. I graduated from an Oklahoma high school and resided in
Oklahoma with a parent or legal guardian for at least two years
prior to graduation from high school, and have not established
domicile in another state.
‐Parent/guardian’s employment verification in Oklahoma
‐Parent/guardian’s Federal Income Tax Return form 1040 OR legal
doc
umentation of custody or guardianship
‐Parent/guardian’s Oklahoma State Income Tax Return form 511
‐(If not a U.S. citizen) documentation of parent/guardian’s
immigration status OR completed and notarized Affidavit of
Intent
B. I am a dependent person and my parent or legal guardian
(who is a U.S. citizen or lawful permanent resident has lived
continuously in Oklahoma for at least 12 months, and has
established domicile in Oklahoma.
‐Parent/guardian’s employment verification in Oklahoma
‐Parent/guardian’s most recent Federal Income Tax Return form
10
40 OR legal documentation of custody or guardianship
‐Proof of parent/guardian’s Oklahoma domicile (ex: most recent
Oklahoma State Income Tax Return from 511; Oklahoma
mortgage statement or lease agreement spanning at least 12
months)
‐(If not a U.S. citizen) documentation of parent/guardian’s
immigration status
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C. I am a dependent person and my parent or legal guardian
has come to Oklahoma to work full‐time or practice a profession
on a full‐time basis.
‐Parent/guardian’s most recent Federal Income Tax Return from
1040 OR legal documentation of custody or guardianship
‐Proof of parent/guardian’s Oklahoma domicile (Okla
homa
mortgage statement or lease agreement spanning at least 12
months)
‐Current letter from parent/guardian’s employer on company
letterhead that is dated, signed by a company official, indicates
date of hire, and clarifies full‐time employment status
‐(If not U.S. citizen) documentation of parent/guardian’s
immigration status
D. I am an independent person, am a U.S. citizen or lawful
‐Employment verification in Oklahoma
permanent resident, have lived continuously in Oklahoma for at
‐Most recent Federal Income Tax Return form 1040
least 12 continuous months (not attending a higher education
‐Proof of Oklahoma domicile (Oklahoma State Income Tax Return
institution), and have established domicile in Oklahoma.
from 511; Oklahoma mortgage statement or lease agreement
spanning at least 12 months)
‐Documentation of self‐support while living in Oklahoma
‐(If not a U.S. citizen) documentation of immigration status
E. I am an independent person and have come to Oklahoma
to work full‐time or to practice on a full‐time basis.
‐Most recent Federal Income Tax Return from 1040
‐Proof of Oklahoma domicile (Oklahoma State Income Tax Return
form 511p; Oklahoma mortgage statement or lease agreement
spanning at le
ast 12 months)
‐Current letter from employer on company letterhead that is
dated, signed by company official, indicates date of hire, and
clarifies full‐time employment status; OR other proof of full‐time
employment in Oklahoma)
‐(If not a U.S. citizen) documentation immigration status
F. I am married to an individual who has already established
Oklahoma domicile and is recognized as in‐state.
‐Copy of marriage license
‐Spouse’s Oklahoma State Income Tax Return form 511 OR other
proof of spouse’s in‐state status
‐(If not a U.S. citizen) documentation of spouse’s immigration
status
G. I am (or am the dependent of an individual) on full‐time,
‐Copy of Armed Forces member’s current orders or letter from
active duty military orders with the U.S. Armed Forces stationed
Oklahoma commanding officer verifying member’s full‐time
in Oklahoma.
active duty status in Oklahoma
‐Most recent military leave and ea
rnings statement
H. Other (please attach a separate document that explains
your circumstances, and include supporting documentation).
Section 3 – HIGH SCHOOL GRADUATION
Name of High School
High School State
High School Graduation Date
________________________________________________
__________________________
_____________________________
Section 4 – PARENT/LEGAL GUARDIAN INFORMATION
Were you claimed as a dependent on anyone else’s federal income tax return for at least the
last year?
YES NO
Parent/Legal
Guardian Name
Relationship to Student
If no, skip to section 5. If yes,
please complete all information in
this section.
Claimed as dependent on fed tax
return?
YES NO
Parent/Legal Guardian Address (Street, City, State, & Zip)
Years at this address
_________________________________________________________________________
__________________
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Parent/Legal Guardian Name
Relationship
to Student
Claimed as dependent on fed tax
return?
YES NO
Parent/Legal Guardian Address (Street, City, State, & Zip)
Years
at this address
My parent(s)/legal guardian(s) are in the United States as: U.S.
CITIZEN
PERMANENT RESIDENT OTHER FOREIGN NATIONAL
Section 5 – MARITAL STATUS
Are
you married?
Yes No If no, skip to Section 6. If yes, please complete all information in this section.
If
yes, please provide spouse’s full name: __________________________________________________________________
My spouse is in the U.S. as:
U.S. CITIZEN PERMANENT RESIDENT OTHER FOREIGN NANTIONAL
Has
your spouse established in‐state status in Oklahoma?
YES NO If yes, how long has your spouse lived in Oklahoma? ___________
Is your spouse employed full‐time in Oklahoma?
YES NO If yes, please enter spouse’s employment information in Section 6.
Section 6 – EMPLOYMENT
IF STUDENT IS A DEPENDENT, LIST EMPLOYMENT OF STUDENT’S PARENT(S)/GUARDIAN(S)
List all employers for the past two years in chronological order (includes employment for you, your spouse, and your
parent(s)/guardian(s), as appropriate). Attach a letter from your employer(s) for the past two years verifying dates of employment
and full‐ or part‐time status.
EMPLOYMENT DATES
EMPLOYER NAME CITY AND STATE HOURS WORKED
PER WEEK
FROM TO
List other sources of self‐support/income: _______________________________________________________________
Section 7 – INTENT
Did you come to Oklahoma primarily to attend school at an institution of higher education?
YES NO
Did you come to Oklahoma primarily to work full‐time, practice a profession, or conduct a full‐time business?
YES NO
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Section 8 – DOMICILIARY INDICATORS
IF STUDENT IS A DEPENDENT, STUDENT’S PARENT(S)/GUARDIAN(S) SHOULD RESPOND TO THSESE QUESTIONS
Answering “Yes” to any of the following questions will not guarantee reclassification to pay in‐state tuition.
Are your registered to vote in Oklahoma?
YES
NO
DATE
OF REGISTRATION (MO., YR)
_____________________________
ATTACH A PHOTOCOPY OF YOUR LATEST
OKLAHOMA VOTER’S REGISTRATION
CARD. (Show front and back of card)
Do you own a motor vehicle?
YES
NO
IN
WHAT STATE IS
IT REGISTERED?
_____________
DATE OF
REGISTRATION
_______________
________
ATTACH A PHOTOCOPY OF YOUR LATEST
MOTOR VEHICLE REGISTRATION
Do you have a current motor vehicle
operator’s license?
YES
NO
IN
WHAT STATE
WAS THE LICENSE
ISSUED?
________________
DATE OF ISSUE
_______________
ATTACH A PHOTOCOPY OF YOUR MOTOR
VEHICLE OPERATOR’S LICENSE AND
EVIDENCE OF THE DATE OF ISSUE
Do you own residential real property in DATE OF PURCHASE
ADDRESS OF PROPERTY
ATTACH
Oklahoma? (MO., & YR)
PHOTOCOPY
YES
OF TITLE TO
NO
________________
______________________________________
PROPERTY
Do you maintain a home(s) in another
state?
YES
NO
LIST
STATE(S)
____________________________________________________________________
Section 9 – PETITIONER’S STATEMENT (ATTACH TYPED STATEMENT IF NECESSARY)
Please provide a written statement that covers the primary reason for your move to Oklahoma and any other information, not
already requested through this petition, that you believe to be relevant to your request for in‐state tuition classification.
Student’s Signature: _______________________________________________________________________ Date
: _______________
FOR ADMINISTRATIVE USE ONLY
Requested additional information(BN)
Reviewed by: ______________________ Comments: ________________________
Reviewed date: ____________________ __________________________________
Approved for In‐State Status(BO)
Petition Denied(BP)
June 2014
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Petition for InState Status (Northeastern Oklahoma A&M College)

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Completed 3 February 2021

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