Residency Reclassification
Student ID
Term: Fall Spring Summer
The burden of proof is on the student to clearly demonstrate both
physical presence in the State of California and to show intent to estab-
lish California residency. The student is required to present evidence in
accordance with Education Code Sections 68040 et. Seq. The docu-
ments presented must be valid, readable, dated at least one year and
one day before the residency determination date, and be properly iden-
tified with respect to student name and address.
Please check item submitted:
California State Income Tax (previous year)
W-2 Form showing address
Documentation of purchase and/or occupation of residential real estate in California.
California Voter Registration
California State Leave of Earnings Statement (Military and Veteran Students only)
Visa Type ________________
Other (Please Specify)
Date Changed
Classified as: California Resident Out of State Resident
Admissions, Records, &Services
Staff Signature
Name Last, First
Staff use only: