320 Corporate Drive
Portsmouth, NH 03801
Phone: (603) 427-7610
FAX: (603) 334-6308
Spring Summer Fall Year_____
REQUEST for CHANGE of RESIDENCY STATUS
Instructions: Complete the form and submit with the appropriate documentation to the Admissions Office.
Deadlines: Request must be made by: September 1—Fall term, January 1—Spring term, June 1—Summer term
Residency Eligibility: No person shall be eligible for a tuition status change unless he/she has been domiciled
within that State continuously for a period of at least twelve (12) months immediately prior to registration. For the
full board policy visit www.ccsnh.edu/boardpolicies.html Click on “Student Affairs Policies” and go to section
740.01 DOMICILE AND TUITION RATE located on page 39. International Students are Not Eligible to request a
change in Residency Status.
Current Program Major: ____________________________________________ Degree Certificate
NAME: Student ID#
A
MAILING ADDRESS PHONE NUMBERS
Number and Street:
Primary Phone: Cell Home Work
P.O. Box:
Secondary Phone: Cell Home Work
City, State, Zip: Email Address:
Student Signature: _________________________________________________________________ Date: _______________
Please change the above named student’s residency status to:
_________ In-State
_________ New England Region Student Program
_________ Out of State
Required Supporting documentation
Please bring with you originals of one of the following as proof of residency:
_____ Driver’s License ____ Voter Registration
For More Information contact:
Great Bay Community College Office of Admissions 320 Corporate Drive, Portsmouth, NH 03801
Phone: : 603-427-7610 Fax: 334-6308 Email: AskGreatBay@ccsnh.edu
ADMISSIONS OFFICE USE ONLY
SAAADMS Effective Term:________ __ Initials:________ Date:_______
REGISTRAR’S OFFICE USE ONLY
SFAREGS Effective Term:________ __ Initials:________ Date:_______ Copy To Bus. Off: __________
Updated 3/30/20
The Community College System of New Hampshire (CCSNH) uses electronic signatures and records in place of traditional ones whenever possible. You will conduct business electronically using a computer with a
supported operating system and internet browser, sufficient electronic storage capacity, a printer and your official CCSNH email account. By logging into CCSNH systems, including but not limited to Banner, SIS and
Canvas, you are opting to conduct electronic transactions with the Community College System and consenting to receive written notices electronically, including those involving financial obligations, and you are
acknowledging that CCSNH can use electronic mechanisms alone to convey critical information related to your admission, financial aid, payment plan, student account, transcript information, registration and other
activities and accounts you may undertake or have as a student at CCSNH. You have a right to request a paper copy of an electronic record. You may withdraw your consent at any time by contacting Student
Services. If you decide to withdraw your consent, however, you may be prevented from registering for classes.
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