Fillable Residency Declaration Form 2017 Latest

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Residency Declaration Form 2017 Latest

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Ofce of Admissions | 4202 E. Fowler Ave., SVC 1036 | Tampa, FL 33620 | P: 813-974-3350 | F: 813-974-9689 | E: admissions@usf.edu
Florida Residency for Tuition Purposes
A Florida “resident for tuition purposes” is a person who has, or a dependent person whose parent or legal guardian has, established and maintained legal
residency in Florida for at least twelve (12) consecutive months preceding the rst day of classes of the term for which Florida residency is sought.
• Residence in Florida must be a bona de domicile rather than for the purpose of maintaining a residence incident to enrollment at an institution of
higher education.
• To qualify as a Florida resident for tuition purposes, you must be a U.S. citizen, a foreign national in a nonimmigrant visa classication that grants you the
legal ability to establish a bona de domicile in the United States, a permanent resident alien, or legal alien granted indenite stay by the U.S. Citizenship
and Immigration Services. Other persons not meeting the twelve-month legal residence requirements may be classied as Florida residents for tuition
purposes only if they fall within one of the limited special categories authorized by the Florida Legislature pursuant to section 1009.21, Florida Statutes. All
other persons are ineligible for classication as a Florida “resident for tuition purposes.”
• Living in or attending school in Florida will not, in itself, establish legal residence. Students who depend upon out-of-state parents for support are presumed
to be legal residents of the same state as their parents.
• Residency for tuition purposes requires the establishment of legal ties to the state of Florida. Students must verify that they have broken ties to other states
if the student or, in the case for dependent students, his or her parent has moved from another state.
Please print if submitting hard copy.
Name of Student: _________________________________________ Date of Birth: __________________ USF ID: _______________________________
Student is a:
□ U.S. Citizen □ Non-U.S. Citizen □ Permanent Resident □ Other
Alien Registration Number: _____________________________________Issue Date: _________________ (A copy of both sides of claimant card is required.)
All non-U.S. citizen students are required to submit documentation of their legal status in the United States as issued by the United States Citizenship and
Immigration Services ofce.
Non-Florida Resident
I do not qualify as a Florida resident for tuition purposes for the term for which this application is submitted. I understand that should I qualify for a future term, it
will be necessary for me to submit an updated Residency Declaration while providing prescribed, supporting documentation to substantiate as “reclassication”
of my status. Submission of this required document must occur prior to the beginning of the term for which residency is sought. I do not have to complete any
further portion of this form except for the signing below.
Name of Student: __________________________________________________________________________________________________________
Signature of Student (Electronic or ink): _____________________________________________________________Date:__________________________
To Be Completed by the Student Seeking Florida Residency for Tuition Purposes
□ I qualify as a resident for tuition purposes, as defined by s. 1009.21, Florida Statutes, for the term for which this application is submitted. I understand that it
will be necessary for me to provide copies of the required documentation upon admission, in order to be considered as a Florida resident for tuition purposes.
I have read the residency information on qualifying as a dependent or independent student, and declare that: (select one of the options below):
□ I am a dependent student, as dened by s. 1009.21(1)(a), Florida Statutes, in that I am eligible to be claimed as a dependent under the federal income
tax code by the claimant below. The claimant is my “parent” as dened by s. 1009.21(1)(f), Florida Statutes, (i.e., either or both parents of the student, any
guardian of a student, or any person in a parental relationship to the student). My parent has maintained legal residence in Florida for at least the past
12 consecutive months. As dened by section 1009.21(1)(d), Florida Statutes, “‘legal resident’ or ‘resident’ means a person who has maintained his or her
residence in this state for the preceding year, has purchased a home which is occupied by him or her as his or her residence, or has established a domicile in
this state pursuant to s. 222.17.” A copy of your parent’s tax return may be requested to establish dependence.
□ I am an independent person who has maintained legal residence in Florida for at least the past 12 consecutive months. I provide 51% or more of my own
support. An independent student generally includes a person who is at least 24 years old, married, a graduate or professional student, a veteran, a member of
the armed forces, a ward of the court, or someone with legal dependents other than a spouse, pursuant to the United States Department of Education for the
purposes of federal nancial aid eligibility.There may be limited cases where a person under the age of 24 years old may qualify as an independent student.
Such students will be required to verify independence (including nancial independence.) A copy your tax return may be requested to establish independence.
Term of Application (check one): □ Fall □ Spring □ Summer Year: 20_____
Ofce of Admissions | 4202 E. Fowler Ave., SVC 1036 | Tampa, FL 33620 | P: 813-974-3350 | F: 813-974-9689 | E: admissions@usf.edu
Florida Residency for Tuition Purposes
To Be Completed by the Claimant/Person Claiming FL Residency:
Note: If the student is a dependent, the parent is the claimant and will complete this section and provide supporting documentation. If the student is
independent, the student is the claimant and will complete this section and provide supporting documentation. No single document shall be conclusive in
establishing residency. Additional documentation, other than what is prescribed, may be requested in some cases. All documentation provided
is subject to verication. Evidence of ties to another state may result in denial of Florida residency for tuition purposes.
Claimant/Name of Person Claiming FL Residency: ________________________________________________________________________________
Claimant’s Relationship to Student: ___________________________________________________________________________________________
Claimant’s Address: ______________________________________________________________________________________________________
Telephone Number: _________________________________________ Date Claimant began establishing legal FL residence: _____________________
Provision of Documents to Support Claim of Florida Residency
Per s. 1009.21(3)(c), Florida Statutes, the residency determination must be documented by the submission of written or electronic verication that includes two or more of the
documents identied below. No single piece of evidence shall be conclusive.
A. Claimant must provide at least one of the following of his/her personal documentation:
□ Florida voter’s registration card
Number: ______________________________________________________ Issue Date: _______________ / ______________ / _______________
□ Florida driver’s license
Number: ______________________________________ Original Issue Date: ______ / ______ / ______ Current Issue Date: ______ / ______ / ______
□ State of Florida identication card
Number:______________________________________ Original Issue Date: ______ / ______ / ______ Current Issue Date: ______ / ______ / ______
□ Florida vehicle registration
Number (VIN): __________________________________ Original Issue Date: ______ / ______ / ______ Current Issue Date: ______ / ______ / ______
□ Proof of permanent home in Florida occupied as primary residence for 12 consecutive months prior to the student’s enrollment. (Required: document such as a
deed or other evidence oftitle to property used as primary residence, a homeowner’s policy, a title insurance policy, evidence of a property tax payment on the
primary residence, or a lease of multiple years’ duration)
□ Proof of a homestead exemption in Florida. (Required: document from the county tax collector demonstrating the application of a homestead exemption to the
claimant’s primary residence.)
□ Ofcial transcripts from a Florida high school for multiple years (2 or more years), if the Florida high school diploma or GED® was earned within the last
12 months.
(Dates of Attendance: ________________________Graduation Date: _______/_______ / _______ ). (Required: transcript)
□ Proof of permanent full-time employment in Florida for at least 30 hours per week for a 12 month period. (Required: pay stubs or W-2 form for past 12
consecutive months)
B. Claimant may provide one or more documents from the following categories to demonstrate residency in Florida (to be used in conjunction
with one document from above):
□ Declaration of domicile in Florida.
□ Florida professional or occupational license.
□ Florida incorporation.
□ Document evidencing family ties in Florida
□ Proof of membership in a Florida-based charitable or professional organization. Any other documentation that supports your request for resident status,
including, but not limited to, utility bills and proof of 12 consecutive months of payments; a lease agreement and proof of 12 consecutive months of payments;
or an ofcial state, federal, or court document evidencing legal ties to Florida.
Ofce of Admissions | 4202 E. Fowler Ave., SVC 1036 | Tampa, FL 33620 | P: 813-974-3350 | F: 813-974-9689 | E: admissions@usf.edu
Florida Residency for Tuition Purposes
Qualication by Exception (to be completed by the student)
As provided in s. 1009.21, Florida Statutes, I qualify for residency based on the following permitted exception (documentation required):
□ I am a qualied beneciary under the terms of the Florida Prepaid College Program (s. 1009.98, Florida Statutes.) (Required: Copy of Florida Prepaid
Recipient card.)
□ I am married to a person who has maintained legal residence in Florida for at least the past 12 consecutive months. I now have established legal
residence and intend to make Florida my permanent home. (Required: copy of marriage certicate and/or other documents required to establish
residency.)
□ I was previously enrolled at a Florida state postsecondary institution and classied as a Florida resident for tuition purposes. I am transferring to
another Florida state postsecondary institution within 12 months of the previous enrollment.
□ I was previously enrolled at a Florida state postsecondary institution and classied as a Florida resident for tuition purposes. I abandoned my
Florida domicile less than 12 months ago and am now re-establishing Florida legal residence.
□ Active duty members of the Armed Services of the United States residing in this state and their spouses and dependent children, and active drilling
members of the Florida National Guard. (Required: Copy of military orders or DD2058 showing home of record.)
□ Active duty members of the Armed Services of the United States and their spouses and dependents attending a Florida College System institution
or state university within 50 miles of the military establishment where they are stationed, if such military establishment is within a county contiguous to
Florida. (Required: Copy of military orders)
□ United States citizens living on the Isthmus of Panama, who have completed 12 consecutive months of college work at the Florida State University
Panama Canal Branch, and their spouses and dependent children. (Required: Copy of marriage certicate or proof of dependency.)
□ Full-time instructional and administrative personnel employed by state public schools and institutions of higher education and their spouses and
dependent children.
□ Students from Latin America and the Caribbean who receive scholarships from the federal or state government. Any student classied pursuant to
this paragraph shall attend, on a full-time basis, a Florida institution of higher education. (Required: proof of scholarship and Latin America or Caribbean
residency.)
□ Southern Regional Education Board’s Academic Common Market graduate students attending Florida’s state universities. (Required: Certication
letter from State Academic Common Market Coordinator.)
□ Full-time employees of state agencies or political subdivisions of the state when the student fees are paid by the state agency or political
subdivision for the purpose of job-related law enforcement or corrections training.
□ McKnight Doctoral Fellows and Finalists who are United States citizens. (Required: Verication from graduate studies.)
□ United States citizens living outside the United States who are teaching at a Department of Defense Dependent School or in an American
International School and who enroll in a graduate level education program which leads to a Florida teaching certicate.
□ Active duty members of the Canadian military residing or stationed in this state under the North American Air Defense (NORAD) agreement, and
their spouses and dependent children, attending a Florida College System institution or state university within 50 miles of the military establishment
where they are stationed. (Required: proof of active duty membership for specied purpose.)
□ Active duty members of a foreign nation’s military who are serving as liaison ofcers and are residing or stationed in this state, and their
spouses and dependent children, attending a Florida College System or state university within 50 miles of the military establishment where the foreign
liaison ofcer is stationed. (Required: proof of active duty membership for specied purpose.)
Residency Declaration
I, the undersigned, hereby declare that I have read the foregoing document and that the facts stated in it are true and further afrm the authenticity of the
information provided on all pages of this Residency Declaration. I understand that any false or misleading information on this Residency Declaration, or provided
in support of this Residency Declaration, will subject me to penalties pursuant to section 837.06, Florida Statutes, for making a false statement. I give permission
for the institution to review or examine any and all documents and records, including those accessible electronically, which may assist in support of my status as
a Florida resident for tuition purposes.
Student Name (Please Print): ________________________________________________________________________________________________
Claimant Name (if not the Student): ___________________________________________________________________________________________
Signature of the Claimant (Electronic or Ink):__________________________________________________Date: ______________________________
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Completed 2 July 2020

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