Fillable RESIDENCY DOCUMENTATION FOR TUITION PURPOSES (Columbia Basin College)

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RESIDENCY DOCUMENTATION FOR TUITION PURPOSES (Columbia Basin College)

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RESIDENCY DOCUMENTATION
FOR TUITION PURPOSES
INDEPENDENT STUDENTS
Independent students are over the age of 24, not claimed
as a dependent on income taxes for any person except
themselves (or spouse) for the last calendar year, and are
nancially independent. Residency for an independent
student is based on the student’s legal state of residence.
❑ Attach a copy of your income tax return for the last
calendar year (rst & signature pages only); nancial
disclosure information is not required and may be
“blocked out” if preferred.
❑ Attach proof of your presence in Washington for the
past twelve (12) months (rent receipts, lease or home
purchase agreement, letter from landlord).
❑ Attach a copy of your Washington State voter’s
registration (voter.votewa.gov/wheretovote.aspx) that
was issued at least twelve (12) months prior to the start
of the quarter.
❑ If you own or use a vehicle, attach a copy of the
Washington State vehicle registration that was issued
at least twelve (12) months prior to the start of the
quarter.
❑ Attach a copy of your Washington State driver’s license
that was issued at least twelve (12) months prior to the
start of the quarter.
❑ Attach a copy of your Washington State bank statement
at least twelve (12) months prior to the start of the
quarter (or letter from bank documenting the date the
account was opened).
❑ Other documents at least twelve (12) months prior
to the start of the quarter that may be submitted in
addition to the above: utility statement, postmarked
envelope, other unbiased documentation.
DEPENDENT STUDENTS
Dependent students are 24 years of age or younger, claimed
as a dependent on income taxes for the last calendar year,
and nancially dependent. Residency for a dependent
student is based on parent(s) state of residence.
❑ Attach a copy of your parent(s)’ income tax return for the
last calendar year (rst & signature pages only); nancial
disclosure information for parents is not required and
may be “blocked out” if preferred.
❑ Attach proof of your parent(s)’ presence in Washington
for the past twelve (12) months (rent receipts, lease or
home purchase agreement, letter from landlord).
❑ Attach a copy of one parent’s Washington State voter’s
registration (voter.votewa.gov/wheretovote.aspx) that
was issued at least twelve (12) months prior to the start
of the quarter.
❑ If your parent(s) own or use a vehicle, attach a copy of the
Washington State vehicle registration that was issued at
least twelve (12) months prior to the start of the quarter.
❑ Attach a copy of one parent’s Washington State driver’s
license that was issued at least twelve (12) months prior
to the start of the quarter.
❑ Attach a copy of your parent’s Washington State bank
statement at least twelve (12) months prior to the start
of the quarter (or letter from bank documenting the date
the account was opened).
❑ Other documents at least twelve (12) months prior to
the start of the quarter that may be submitted in addition
to the above: utility statement, postmarked envelope,
other unbiased documentation.
Students who are classied as non-residents at the time of their admission may be eligible to establish
residency for tuition and fee purposes. Students must be able to document their “intent” to establish
Washington as their permanent domicile (residence) at least twelve (12) months immediately prior to the
start of the quarter for which they are applying.
Submit ONLY after you have met all residency requirements
TO APPLY FOR RESIDENT STATUS FOR TUITION PURPOSES, THE FOLLOWING ARE REQUIRED:
1. Residence Questionnaire
It’s essential that the questionnaire be lled out completely and legibly. Failure to do so may delay a decision on your
behalf.
2. Documents required on the Residence Questionnaire
Establish whether you will be applying as a nancially independent or dependent student and submit the required
documents listed below (if the document is not available, provide a statement to that fact). Documents become a part of
your le and are not returned.
THINGS TO KEEP IN MIND
• Must be submitted prior to the 30th calendar day of classes of the quarter for which you are seeking residency.
Documentation received after the 30th calendar day will be considered for the following quarter.
• Submit questionnaire and documentation together, as your questionnaire will not be processed until all documentation
is received. Please only provide what is required.
• To speed your request, make sure the information is complete and correct.
• Decisions on resident status are based on documents submitted, which become a part of your le and are not returned.
• You are responsible for paying tuition and fees while awaiting a determination of your residency status. If the
determination is made that you qualify for resident status after you’ve paid tuition as a non-resident, a refund will be
processed for the difference.
• You must prove conclusively that you have established a bona de domicile (residence) in Washington State for reasons
other than education for 12 months prior to the start of the quarter for which they are applying for recognition of
Washington State residency.
• Residency policies are set by the State of Washington (RCW 28B.15).
Completed Residence Questionnaire and documentation may be mailed or submitted in person.
Submit by US Mail:
Student Records
Columbia Basin College
2600 N. 20th Avenue, MS-H4
Pasco, WA 99301
Submit In Person:
Hawk Central
H Building
Pasco Campus
We are temporarily unable to accept this form 'In Person' while our campuses operate remotely.
Please submit the completed form and documentation via USPS
or from your CBC student email to records@columbiabasin.edu.
Columbia Basin College complies with the spirit and letter of state and federal laws, regulations and executive orders pertaining to civil rights, Title IX, equal opportunity and afrmative action. CBC does not discriminate on the basis of race, color, creed, religion, national or ethnic origin, parental status or
families with children, marital status, sex (gender), sexual orientation, gender identity or expression, age, genetic information, honorably discharged veteran or military status, or the presence of any sensory, mental, or physical disability, or the use of a trained dog guide or service animal (allowed by law)
by a person with a disability, or any other prohibited basis in its educational programs or employment. Questions or complaints may be referred to the Vice President for Human Resources & Legal Affairs and CBC’s Title IX/EEO Coordinator at (509) 542-5548.Individuals with disabilities are encouraged
to participate in all college sponsored events and programs. If you have a disability, and require an accommodation, please contact the CBC Resource Center at (509) 542-4412 or the Washington Relay Service at 711 or 1-800-833-6384. This notice is available in alternative media by request.
Residence Questionnaire
Directions: Please print clearly and answer each question. Incomplete or illegible forms cannot be considered and will be returned. Falsification or
intentionally erroneous information is subject to perjury under the laws of the State of Washington, RCW 9A.72.085. All information will be kept
confidential in accordance with the Family Educational Rights and Privacy Act of 1974. Once a domicile is established in Washington, it must continue
for one year before you are eligible for resident tuition.
SECTION 1
Name (Last, First, MI)
Day Phone Number
FOR OFFICE USE ONLY
( )
Type
Address (Street, State, Zip)
Student ID Number Status
DEP INDEP
E-mail Address
Birth City, State, Country
Birth Date
Age
Today's Date
1. Last high school attended _________________________________________ State ___________ Year Graduated _____________
Effective Date
2. For what term are you now seeking
residence classification? Year 20___
Fall
Winter
Spring
Summer
If you have previously applied at this institution for a change in residence status, indicate: Term __________ Year __________
Resident Non-Resident
3. Class Standing: Undergraduate Graduate Professional School: _______________________________________
____________________________________
Residence Classification Officer
4. At this Institution, you are or will be enrolled as a:
New Student
Continuing Student
Returning Former Student
If continuing or former student, give number of credit hours for which you were registered during each of the last three terms and identify each term by session and year:
C
redits ______ Term __________ Year __________ | Credits _______ Term __________ Year ___________ | Credits _______ Term __________ Year __________
5. Country of citizenship: 5a. Do you hold permanent or temporary resident immigration status?
Yes
No
If not USA, answer 5a, 5b and 5c. 5b. Do you hold "Refugee-Parolee," "Conditional Entrant" or PRUCOL status?
Yes
No
5c. Do you hold a visa classification of A, E, G, H-1, I, K, or L?
Yes
No
Note: An immigrant refugee, and the spouse and dependent children of
such refugee, may be exempted from paying the nonresident tuition fees
differential if the refugee (a) is on parole status, (b) has received an
immigrant visa, or (c) has applied for U.S. citizenship.
If yes to any of the above, you must attach a copy of both sides of Resident
Alien Card, Form I-94, or other documentation. (If you are not a citizen of the
United States and do not hold permanent or temporary resident immigration
status, "Refugee-Parolee", "Conditional Entrant", PRUCOL status or an A, E,
G, H-1, I, K, or L visa, you cannot be classified as a resident.)
6. Have you received financial assistance from a state governmental unit or agency
during the past twelve months?
If yes, indicate state, agency, type of assistance, disbursement dates, etc.
7. Will you be receiving state financial assistance during the next twelve months?
Yes
No
If yes, indicate state, agency, type of assistance, disbursement dates, etc.
SECTION 2
1. Are you applying for resident status as a dependent
student whose parent or court -appointed legal guardian
has maintained a bona fide domicile in the State of
Washington for at least one year?
Yes
No
If yes, your parent or legal guardian must complete SECTION 3 of this form, providing proof of his/her
Washington domicile and all requested supporting documentation. Verification of your dependent status
must be documented by submitting a true and correct copy of your parent's or legal guardian's state and
federal income tax return for the most recent tax year. The extent of the disclosure required concerning
the parent's or legal guardian's state and federal tax returns is limited to the listing of dependents claimed
and the signature of the taxpayer and shall not require disclosure of financial information contained in the
returns.
2. Are you applying for resident status as a financially
Independent student?
Yes No
If yes, you must complete Section 3 of this form and provide all requested supporting documentation.
2a. Student's Sworn Statement:
I have not been and will not be claimed as an exemption for federal Income tax purposes by any person except myself or my spouse for the current calendar year and for the
calendar year immediately prior to the year in which this application is made; and I have not received and will not receive financial assistance in cash or in kind of an amount
equal to or greater than that which would qualify me to be claimed as an exemption for income tax purposes by any person except myself or my spouse during the current
year and for the calendar year immediately prior to the year in which this application is made.
Signature _________________________________________________________________________________________________ Date ___________________________
2b. To further substantiate your financial Independence, you are required to submit appropriate documentation.
• A true and correct copy of your state and federal income tax return for the calendar year immediately prior to the year in which this application is made. If you did not file a state or federal
income tax return because of minimal or no taxable income, documented information concerning the receipt of such nontaxable income must be submitted.
• A true and correct copy of your W2 form filed for the previous calendar year.
• Other documented financial resources. Such other resources may include but are not limited to, the sale of personal or real property, trust fund, state or financial assistance, gifts, or earnings of
the spouse of a married student.
• If you are 24 or younger, provide a true and correct copy of the first and signature page of the state and federal tax return of your parents, legally appointed guardians, or person or persons who
have legal custody of you for the calendar year immediately prior to the year in which this application is made. The extent of the disclosure required concerning the parent's or legal guardian's
state and federal tax returns is limited to the listing of dependents claimed and the signature of the taxpayer and shall not require disclosure of financial information contained in the returns.
3. Are you on active duty military stationed in the state of Washington or the spouse or dependent of such a person? Yes No
4. Did you spend at least 75% of both your junior & senior years in a Washington state high school, and did you enroll in college within 6 months of leaving high school, and were
your parents/legal guardians domiciled in Washington for at least 1 year within the 5-year period before you graduated from high school?
Yes
No
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Directions: Do not leave any questions blank. No decision can be made unless all questions are completed and all required documentation is
submitted.
SECTION 3
1. This section is being completed and signed by:
Parent
Legal Guardian
Student
Date of your arrival in Washington :
Month: ________ Day _______ Year ______
Purpose of moving to Washington:
Date you took action to officially declare Washington as
your permanent, legal domicile:
Month: ________ Day _______ Year ______
2. List chronologically your employment and physical residence for the last two years giving exact information as requested below. If you were not employed, list your physical residence for
the last two years. Attach additional page if necessary.
DATES OF EMPLOYMENT
LOCATION
OCCUPATION
HOME ADDRESS
Mo. Day Yr.
Mo. Day Yr.
City State
Employer Hrs/wk
Street City State
Note: You must provide proof of your physical presence in Washington the past 12 months (e.g. copies of rent receipts, lease or home purchase agreements, cancelled rent
checks, letter from landlord, letter from employer, etc.).
3. If you were out of Washington during the last 12 months, give dates, and reasons for your absence:
DATES OF ABSENCE
LOCATION
PURPOSE OF ABSENCE
Mo. Day Yr.
Mo. Day Yr.
City State
4. Have you ever
registered to vote?
Yes
No
If yes, attach a
copy of your
current voter's
card.
If yes, list date, city and state for your last two registrations.
Date ____________ City __________________________ State ________ Date Voted ____________
Date ____________ City __________________________ State ________ Date Voted ____________
5. Do you own or use any
motor vehicles, RV’s,
boats or mobile homes?
If yes, give type of vehicle, license number, state and dates of registry. You must attach a copy of vehicle registration (not the title).
Ty
pe of vehicle ________________________ License Number __________________________ State __________ Date of Registry ___________
Yes
No
Ty
pe of vehicle ________________________ License Number __________________________ State __________ Date of Registry ___________
6. Do you have a valid
driver's license?
If yes, you must attach
a copy of your current
driver's license.
If yes, in what state:
___
______________________
When did you first obtain a driver's license in that state?
Da
te ______________________________
Yes
No
Previous driver's
license?
Yes No
If yes, in what state:
___
______________________
When did you first obtain a driver's license in that state?
Date ______________________________
7. Do you have a bank
account?
Yes No
If yes, please attach
documentation of date
you opened account.
If yes, since what date?
___
______________________
Name of Bank _______________________ Branch _______________
Ci
ty ________________________________ State ________________
8. Have you ever paid
in-state tuition at any
public institution of
higher education?
Yes No
If ye
s, date of last term __________________________________________
Name of Institution _____________________________________________
Dates Attended: From _____________________ To __________________
8a. Have you ever attended a Washington college/university for more than 6
hours per term?
Yes No
If yes, where _________________________________________________
Dates attended From____________________ To ___________________
9. Are you a US Citizen?
Yes No
If no, attach a copy of your Resident Alien Card, I-94 or other INS documentation.
10. List business or
professional licenses
(name & state of issue)
___
___________________________________________________________________________________________________________
Additional Comments:
STATEMENT OF INTENT
I certify that I have declared
Washington as my true, fixed,
and permanent place of
habitation.
Signature of Parent (if completing SECTION 3) ___________________________________ Date ______________
CERTIFICATION
Parent Address (Street, City, State) _______________________________________________________________
I certify under penalty of
perjury under the laws of the
State of Washington, RCW
9A.72.085 that the foregoing
and all supporting
documentation are true and
correct.
Signature of Student _________________________________________________________ Date ______________
AG Form #151 – Revised 1/15/02 – AG Approval 4/19/02. Revised by WSAC (previously known as HECB - 6/2009), AG approval 6/10/2009, effective 7/01/2009.
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RESIDENCY DOCUMENTATION FOR TUITION PURPOSES (Columbia Basin College)

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Completed 21 July 2020

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