Fill - Free fillable Residency-status-application-2015-03-09 - PDF Form Residency Short Form 2015-03-09 PDF form

Revised 03/09/2015

OFFICE USE ONLY

Resident ______ Non-Resident ______ Approved By ____________________________

Date Received ____________ Date Notified ____________ Notified By _______ Email ____ Phone ____

Pending Additional Information ___________________ Appeal _______ By/Date_______________________ /___________

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RESIDENCY QUESTIONNAIRE

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Additional information is needed to determine your residency status. Complete, print, and sign this form then return it with

your supporting documentation to the Gateway Community & Technical College Registrar, 790 Thomas More Parkway,

Edgewood KY 41017. If you have any questions, please contact us at (855) 346-4282 or gateway-admissions@kctcs.edu

Please complete all fields. Any fields that do not apply, mark with “N/A” or leave blank. Incomplete forms will not be processed

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PLEASE PRINT

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First Name: ________________________ Middle:______________________ Last: _________________________________

Address: _________________________________________________

City:

__________________________

State:_________ Zip:_________

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Phone

Number:___________________

Student ID:______________________ Date of Birth:___________________________

Email Address:_________________________________________________

Are you a U.S. citizen?

_____ If yes, what is your citizenship status? __

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If not a U.S. citizen, what is your visa type?

______________________________________________________

______________

When did your present stay in the State of Kentucky begin? ______________________________________________________

What was your reason for coming to Kentucky? ________________________________________________________________

How long have you continuously lived in Kentucky? _____________________________________________________________

When did you last file a Kentucky income tax return? ___________________________________________________________

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What term are you applying for:

_ 20_____

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Are you currently active duty military, stationed in Kentucky?

______

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Are you a spouse or dependent of active military personnel, stationed in Kentucky?

____

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If yes, list the name of the person and your relationship to him/her:

_______________________________________

________

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* Military ID and copy of the sponsor’s orders to Kentucky military base are required.

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Did you graduate from a Kentucky high school?

______

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Name of high school: _______________________________________________________

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Have you attended any other college, university or private high school in the past three years?

If yes, complete the following section:

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______

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Reset Form

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If you attended another college, university or private high school, please complete the following information about your

residency status. If residency for tuition purposes is not applicable at an institution, please check “N/A.”

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Please check one: Type of Tuition Paid

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College

University

Private

High School (No Abbreviations)

Resident

Non

resident N

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If someone other than yourself provides major financial support to you (such as books, tuition, housing, or transportation)

please provide their name, address, and relationship to you:

Is this person employed? _

___

If yes, provide the following information:

Employer City State From To Part/Full Time

_______________________________________________________________________________________________________

Where have your parents or guardians lived for the last two years?

City State From To

______________________________________________________________________________________________________

Where have you lived for the past 12 months?

Address City State From To

_______________________________________________________________________________________________________

Are you employed?

____

If yes, provide the following information:

Employer City State From To Part/Full Time

_______________________________________________________________________________________________________

Please provide a full explanation of the reason(s) why you believe you should be considered a Kentucky resident for fee

purposes. If additional space is required, please attach a separate sheet.

I certify that all information I have provided above is true to the best of my knowledge. I understand that if I provide

fal

information, my residency status may remain as out-of-state at Gateway Community & Technical College.

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_______________________________________

_____________________

Student Signature Date

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Residency

Information

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Below is information you may find useful to help you during the residency review process. If you have

questions regarding your application for residency please contact the Admissions Office at

(855) 346-4282 or by email at gateway-admissions@kctcs.edu Submit your completed form and

supporting documentation to:

Gateway Community & Technical College

Attention: Registrar

790 Thomas More Parkway

Edgewood, KY 41017

(855) 346-4282

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Before you apply:

 Know the tuition deadline. Filing a residency appeal does not count as payment.

 Please allow one week between filing and the tuition deadline if the outcome of your appeal

makes a difference in your enrollment. If you apply for residency within three (3) business days of

the tuition deadline you need to be aware that your appeal may not be reviewed prior to tuition

being due and you are responsible for your full balance or withdrawing from your courses.

 If you choose to stay in courses past the tuition deadline and your appeal is denied this

appeal is not grounds for a 100% withdrawal from your courses.

 If you are filing as a dependent student you need to supply your parent or guardians information

as documentation. (Example: Parent/guardian driver’s license, lease/mortgage statement,

and/or state tax papers with you identified as a dependent.)

 To be considered for a change of status in a current term you must apply within 30 days of the

start of the semester. Any request received after this date will be considered only for future

enrollment.

 Please provide your mailing address and a phone number where you can be reached or have

access to voicemail.

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After you apply:

 Pay your tuition by the tuition deadline.

 If additional information is needed, the Residency Officer may contact you by phone. Please

respond to any inquiries about your residency appeal within five (5) business days. If the

Residency Officer does not hear from you this may be reason for denial.

 Every student has the right of appeal through the Residency Appeal Committee. This is a formal

hearing process that is outlined to you if your appeal is denied.

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