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SEASONAL AGRICULTURAL EMPLOYMENT VERIFICATION (Allan Hancock College)

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SEASONAL AGRICULTURAL EMPLOYMENT VERIFICATION
You may be exempt from paying non-resident tuition if you, or your parent, earned a livelihood primarily by
performing agricultural labor (seasonal employment in connection with actual production of agricultural crops,
including seeding, thinning and harvesting) for hire in California and other states for at least
two months per year in
each of the last two years. If you are claiming residency based on this rule, please complete and sign the form
below:
AHC Student ID Number: H_____________________________
Student Name: _____________________________________________________________________
Address:
Street: _____________________________ City: _____________________________ Zip___________
I am a seasonal agricultural employee -or-
My parent is a seasonal agricultural employee (complete parent information):
Parent Name: ____________________________ Phone Number ( ) ________- ____________
Address:
Street: _____________________________ City: _____________________________ Zip___________
Did your parent file state and/or federal income tax returns?
□ Yes □ No
If yes, were you claimed as a dependent?
□ Yes □ No
*************************************************************************************************************
Company Name: ___________________________________________________________
Employer’s Name: _____________________________
Employer Phone Number (______) ________-______________
____________________________________________ _____________________
Employer’s Signature Date
Proof: Attach pay stubs showing two months employment for the last two years, or attach a copy of your Migrant
Education Program certificate of eligibility or ask your employer to sign this form.
I certify that the statements on this form are true and correct and that I, or my parent, meet the qualifications for this
exemption. I will notify the college of any changes in information.
________________________________________ _____________________
Student’s signature Date
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VERIFICACION DE EMPLEO DE TRABAJADORES AGRICOLAS
Puede que usted esté exento de pagar la cuota de inscripción, si usted, o sus padres, han ganado sus ingresos
como trabajadores agrícolas (trabajadores del campo por temporadas en empleos de cosecha de productos
agrícolas, incluyendo el sembrar, preparar y cosechar) que son contratados en California o en otros estados
por
lo menos durante dos meses por año durante los últimos dos años . Si usted está solicitando la residencia
basándose en esta regla, favor de completar y firmar esta solicitud:
AHC Numero del Estudiante: H _________________________
Nombre del Estudiante: _________________________________________
Domicilio:
Calle: _______________________________________________
Ciudad: ___________________________________
Código Postal
______________
Soy trabajador del campo por temporadas -o-
Mis padres son trabajadores agrícolas por temporada (completar información de los padres):
Nombre del Padre/Madre: ____________________
___________________________
Teléfono:
(_______) ________- ____________
Calle: _______________________________________________
Ciudad: ___________________________________
Código Postal
______________
¿Sus padres hicieron su declaración de impuestos?
□ Sí □ No
¿Si sí, lo declararon como dependiente?
□ Sí □ No
*************************************************************************************************************************
Nombre Compañía:
__________________________________________________________
Nombre Empleador:
_____________________________
Teléfono de Empleador:
(______) ________-______________
____________________________________________ ____________________
Firma Empleador Fecha
Comprobante: Incluya talones de cheque que demuestran dos meses de empleo durante los dos últimos años,
o incluya una copia de su certificado de elegibilidad para el Programa de Educación Migrante o pídale a su
empleador que le firme esta solicitud.
Yo certifico que las declaraciones en esta solicitud son verdaderas y correctas y que yo o mis padres, tenemos
los requisitos para calificar para estar exentos. Yo notificare al colegio de cualquier cambio de información.
____________________________________________ ____________________
Firma del estudiante Fecha
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Completed 25 July 2020

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