Revised 03/09/2015
Resident ______ Non-Resident ______ Approved By ____________________________
Date Received ____________ Date Notified ____________ Notified By _______ Email ____ Phone ____
Pending Additional Information ___________________ Appeal _______ By/Date_______________________ /___________
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
Please complete all fields. Any fields that do not apply, mark with “N/A” or leave blank. Incomplete forms will not be processed
First Name: ________________________ Middle:______________________ Last: _________________________________
Address: _________________________________________________
State:_________ Zip:_________
Student ID:______________________ Date of Birth:___________________________
Email Address:_________________________________________________
Are you a U.S. citizen?
_____ If yes, what is your citizenship status? __
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? ___________________________________________________________
What term are you applying for:
_ 20_____
Are you currently active duty military, stationed in Kentucky?
Are you a spouse or dependent of active military personnel, stationed in Kentucky?
If yes, list the name of the person and your relationship to him/her:
* Military ID and copy of the sponsor’s orders to Kentucky military base are required.
Did you graduate from a Kentucky high school?
Name of high school: _______________________________________________________
Have you attended any other college, university or private high school in the past three years?
If yes, complete the following section:
Reset Form
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.”
Please check one: Type of Tuition Paid
High School (No Abbreviations)
resident N
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
information, my residency status may remain as out-of-state at Gateway Community & Technical College.
Student Signature Date
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 Submit your completed form and
supporting documentation to:
Gateway Community & Technical College
Attention: Registrar
790 Thomas More Parkway
Edgewood, KY 41017
(855) 346-4282
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
Please provide your mailing address and a phone number where you can be reached or have
access to voicemail.
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.