IN-STATE TUITION STATUS graduate students only *
If you are a resident of the District of Columbia, Northern Virginia (Arlington, Loudoun, Fairfax and Prince William counties
and Alexandria, Fairfax, Falls Church, Manassas and Manassas Park), Pennsylvania (Adams, York and Lancaster counties)
and Delaware (all counties) you may apply for a regional residency determination.
Name: _____________________________________________________________ Date of birth: ________________
Email: _______________________ Home phone number: _________________ Cell: _________________________
Is your permanent residence in one of the areas listed above? Yes No
Permanent Address: _______________________________________________________________________________
street city state/province zip
How long have you lived at your permanent address? Years: _____Months: _____
Previous Address: __________________________________________________________________________________
street city state/province zip
How long did you live at your previous address? Years: ____ Months: _____
I am financially independent. I have earned taxable income and I have not been claimed as a dependent on another
person’s most recent income tax returns.
a. Have you filed a state tax return in the most recent tax year in any of the following states/districts?
DC, DE, PA, VA? Yes No
b. Please list the years you filed a state return in the above state/districts in the last two years:
c. Please state any reasons for not filing in one of the following states/districts (DC, DE, PA, VA) in the last
12 months: _______________________________________________________________________
d. Is income tax being withheld from DC, DE, PA or VA from your pay? Yes No
e. Did you receive any public assistance from any agency not in DC, DE, PA or VA? Yes No
I am financially dependent. Another person has or will claim me as a dependent on his/her most recent income tax
a. Name of person upon whom dependent and relationship: __________________________________
b. How long have you been dependent upon this person? _____________________________________
I am a ward of the State.
*Regional residency only applies to students and credits associated with a UB graduate program. Undergraduate degrees
and certificates, doctoral, law and advanced professional degrees are not included.
IN-STATE TUITION STATUS graduate students only *
1. Do you possess a valid driver’s license or identification card? Yes No
a. If yes, date of issue: __________ in what state: _____________
2. Do you own any motor vehicles? Yes No
a. If yes, initial date of registration (mm/yyyy): _________ in what state: ___________
b. Most recent date of registration (mm/yyyy): _________ in what state: ___________
3. Are you registered to vote? Yes No
a. If yes, in what state? __________ Date of registration: ___________
4. Were you previously registered to vote in another state? Yes No
a. If yes, what state? ____________
I certify that the information provided is complete and correct. I understand that the university reserves the right to request
additional information if necessary. In the event the university discovers that false or misleading information has been
provided, the student applicant may be billed by the university retroactively to recover the difference between in-state and
out-of-state tuition for the current and subsequent semesters.
SIGNATURE OF APPLICANT: ______________________________________________________DATE: ___________
SIGNATURE OF PARENT (if applicant is under the age of 18): ______________________________ DATE: ___________
The following questions are required by federal law. If you answer “yes” to any of them, please attach a letter of
explanation addressing in detail the nature of the incident, when it occurred and its resolution.
a. Have you ever been convicted of a crime, other than a minor traffic violation, for which the charges have not been
expunged or pardoned? Yes No
b. Have you ever been academically dismissed from or declared ineligible to attend any previous institution, including
the University of Baltimore? Yes No
c. Has disciplinary action been initiated or taken against you at any of the institutions you previously attended,
including the University of Baltimore? Yes No
I certify that the information provided is true and complete to the best of my knowledge. If it is not, I understand that
cancellation of my class registration my result.
SIGNATURE OF APPLICANT: ________________________________________ DATE: ____________________________
SIGNATURE OF PARENT (if applicant is under the age of 18): ______________________________ DATE: ___________
The Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act requires that colleges and universities publish and
distribute an annual security report. You may view and download this document by visiting
Nondiscrimination policy: The University of Baltimore (“UB” or “University”) does not discriminate on the basis of sex, gender, race,
religion, age, disability, national origin, ethnicity, sexual orientation, gender identity or other legally protected characteristics in its
programs, activities or employment practices. Inquiries regarding discrimination related to educational programs and activities should be
directed to the Title IX coordinator, Anita Harewood, vice president, Office of Government and Community Relations, Academic Center,
Room 336, phone: 410.837.4533,; dean of students, Office of Community Life, Academic Center, Room 112, phone:
410.837.4755,; or assistant vice president, Office of Human Resources, Charles Royal Building, Third Floor,
410.837.5410, This includes inquiries regarding Title IX of the Education Amendments of 1972 as amended (“Title
IX”) and Section 504 of the Rehabilitation Act of 1973.