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SOLANO COMMUNITY COLLEGE SUPPLEMENTAL RESIDENCY QUESTIONNAIRE (UNDER 19) (Solano Community College)

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SOLANO COMMUNITY COLLEGE
SUPPLEMENTAL RESIDENCY QUESTIONNAIRE
(UNDER 19)
Students may be required to complete a supplemental residency questionnaire to clarify
residency or apply for residency reclassification. Residency changes are not automatic. To qualify
for
California residency, you must:
1) Be physically present in the state of California for at least one year and one day prior to the start of
the semester (Act)
2) Show documentation of current intent to establish California residency (Intent) and
3) Reside in the United States with the legal status to establish residency.
The burden of proof is on the student to clearly demonstrate both physical presence and intent to establish residency.
All documents presented must be valid, legible, dated at least one year prior to the residence determination date and be
properly identified with the student’s name and address.
Name: Student ID:
Last First
Middle
Physical
Address:
Street
City
State
Zip Code
Are you currently a foster youth (ward o
r dependent of the State of California) or emancipated foster youth?
Yes No
With whom do you currently reside?
Both parents Mother only Father only Legal Guardian Other
If you do not live with either parent, are you under continuous
an
d direct care of any person(s) other than your parent?
Are your parents deceased?
Both parents Mother only Father only
Yes – since _____________________________
No
Have you ever been married? Yes
please answer all questions below based on your information
No
please answer all questions based
on the parent(s) or guardian(s) with whom you
currently reside. If you do not reside w
ith your parent or guardian, use the information of
the parent or guardian with whom you last resided.
To request CA residency - On what date did your or your parent/guardian’s present stay in California begin?
__________________________________________________________________
Please list the addresses where your parent/guardian (or
you if married) have lived during the last two years:
Dates:
Street City State
Street City State
Street City State
Street City State
In the last year, have you or your parent/guardian :
In California
In another state
Registered to vote or voted? Yes No Yes No
Petitioned for a divorce as a reside
nt of a specific state?
Yes No Yes No
Attended an out-of-state institut
ion as a resident of the state where the
institution is located?
Yes No Yes No
In the last year, have you declared non-re
sidence for state income tax
purposes?
Yes No Yes No
If yes to any of the above, ple
ase give a brief explanation:
Yes No
Have you or has your parent/guardian entered t
he United States under any of the vis
a types below or
in an illegal (undocumented or expired visa) status?
B-1, B-2, C, D-1, D-2, F-1, F-2, H-2, H-3, J-1, J-2, M-1, M-2, O-2, P-1, P-2, P-3, P-4, Q, TN, TD
Yes No
Since entering the United States, ha
ve you (if married) or has your parent/guardian
applied for
permanent residence status, asylu
m, Temporary Protected Status, Family Unity Program, legalization
or been granted a change of visa status?
Yes* No
*Date of application:
Verified by:______
____ CA Resident
____ Nonresident
____________________________________________________________________
___________________
___________________________________________________________________________________________________
Phone# __________________________ Date of Birth _____________________ Email ____________________________________
Documentation
At least two documents are required to show proof of Act and Intent. The more evidence that you provide to prove your intent to be
a resident, the easier it will be for you to establish California residency for tuition purposes. All documents used to establish
residency must include:
1. The student's name (or parent's name if student is under 19 and unmarried)
2. The student's physical address in California (or parent's physical address if student is under 19 and unmarried)
3. Be dated at least one year and one day prior to the start of the semester, but also be recent enough to show that the
student has proven Act and Intent.
Activity/Documentation Type
Date Issued/Begun:
California State Income Tax return (with valid California address)/Federal Income Tax
Return (with valid California address) California 540 tax form preferred
W-2 form showing a California physical address
Mortgage, title or rental agreements showing the physical address where the student lives
Utility or other bills showing a California physical address
California voter registration
California Driver's License or Identification Card
Automobile or other insurance showing a California physical address
Documentation of having received California state services such as unemployment, rehabilitation,
welfare, etc
Active California bank account for one year prior to residence determination date
California vehicle registration
Recent high school transcript or other California college transcript showing enrollment
Selective Service registration with a permanent California address
Jury duty summons for a California court
Do you qualify for special consideration under any of the following categories?
• Under 19 years of age and have supported yourself financially for at least one year and a day
• Member of the military on active duty in California or remaining in California after discharge
• Dependent (child or spouse) of a member of the military stationed in California
• Public school employee with a valid credential or emergency permit
• Full-time employee (or dependent of an employee) of a California State agency assigned to work outside of California
• Full-time employee (or dependent of an employee) of a California Community College, the California State University, the University of
California or California Maritime Academy.
• In the process of being classified as a peace officer AND enrolled in police academy training courses at SCC
• Graduate of a school in California operated by the United States Bureau of Indian Affairs
• Surviving dependent of any individual killed in the September 11th terrorist attacks
• Self-supporting minor or minor under the care and control of individuals other than a parent/guardian for the past two years
I certify under penalty of perjury that the information submitted is true and correct. I agree to notify the Admissions &
Records Office if there is any change in my residence, immigration status, or other facts used in determining residency
while I am a student at SCC. I understand that falsifying information could result in criminal charges for perjury and/or fraud;
student disciplinary action; and/or accumulated monetary damages resulting from non-payment of non-resident tuition. I further
understand that all documents submitted by me with this supplemental residency questionnaire become the property of Solano
Community College.
Signature
Date
SOLANO COMMUNITY COLLEGE
RESIDENCY - SPECIAL CONSIDERATION REQUIREMENTS
California regulations allow students meeting certain criteria to pay California resident fees even if they have
not met the requirements of physical presence and intent to be a resident. To be considered under these
special provisions, please see
the applicable section below.
Self supporting minor
If you are under 19 years of age
and have supported yourself financially
for at least one year and a day, please provide both
of the following:
1. W
-2 forms or other documentation showing your earnings for
the past year.
2. A written statement showing your expenses during the past
year.
Note: To claim this status, you must have been physically present in
California for the past year.
Member of the U.S. Military on active duty in California
or maintaining home of record in California
If you are a member of the United States Military (Army, Navy, Air
Force, Marines, or Coast Guard) assigned to active duty for more than
30 days, please provide one of the following:
1. Military orders to current duty station in California.
2. Documentation that you are assigned to active duty in any
location and maintain your primary home in California.
Spouse or dependent child of a member of the
military stationed in California or maintaining home of
record in California
If you are the spouse or dependent child of a member of the Armed
Forces of the United States who is stationed in California, please
provide all of the following:
1. Military member's orders reflecting active duty assignment for
more than 30 days to current duty station in California military
member's orders to active duty assignment in California OR
the military member's initial orders reflecting home of record
in California.
2. Evidence that you are the spouse of the military member or a
dependent child for federal tax purpose. Please provide one
of the following:
a. DEERS print out listing the student as the spouse or
dependent child, or
b. Orders specifically listing student as the spouse or
dependent of military member.
Discharged member of the U.S. Military remaining in
California
If you were a member of the United States Military who was stationed in
California for more than one year immediately prior to being discharged
and you have remained in California for less than a year and one day,
please provide a copy of your Military Discharge Form (DD214 Member
4 OR copy 2 OR copy 7). You may be temporarily classified as a
California Resident for up to one year, but will need to provide evidence
of intent to establish California residency at the end of the one-year
waiting period to maintain your residency status.
1. Copy of your credential or emergency permit, and
2. Statement from your employer that you are employed in a full-
time position requiring certification qualifications.
Foster Care Youth/Emancipated Foster Youth
If you are or have recently been a foster care youth (ward or dependent
of the State of California), please provide documentation showing this
relationship.
Employee (or the spouse or child of an
employee) of a
California state agency assigned to work outside of
California
If you, your parent or spouse is
employed full-time by a California state
agency and is assigned to work outside of California, please provide
both
of the following:
1. Proof of employment
2. Proof of assignment outside of California
Employee (or the spouse or child of an employee) of a
California Community College, California State University
or Colleges, the University of California, or the California
Maritime Academy
If you, your parent or spouse is employed full-time by one of the
California institutions listed above, please provide all of the following:
1. Proof of employment
2. Proof that the student has not lived in California for more
than one year since arriving or since attaining age 18,
whichever came later.
In the process of being classified as a peace officer and
are enrolled in police academy training courses at SCC
If you are currently enrolled in police academy training courses and a
public agency intends to classify you as a police officer upon successful
completion of the courses, please provide evidence that the public
agency intends to classify you as a peace officer.
Graduate of a school in California operated by the
United States Bureau of Indian Affairs
If you are a graduate of a school
operated by the United States Bureau
of Indian Affairs that is located in California, please provide a copy of
your diploma.
AB540 Exempt
If you attended a California high school for at least three years and
graduated or received a certificate of completion, please request and
complete the AB540 Tuition Exemption form.
Public school employee with a valid credential or
emergency permit
If you are employed by a school district in a full-time position and
hold a valid credential or valid emergency permit and are enrolled in courses
to meet credential requirements, please provide both of the following:
Spouse and/or dependent children of a discharged
member of the U.S. military remaining in California
If you are a spouse and/or dependent child of a discharged member of
the U.S. military who was stationed in California for more than one year
immediately prior to being discharged and you have remained in
California for less than a year and one day, please provide a copy of the
Veterans Military Discharge Form (DD214 Member 4 OR copy 2 OR copy
7) and one of the following:
1. For spouses: Marriage license or IRS tax form 1095-A from most
recent federal tax return
2. For dependents: Birth certificate or legal guardian documents or
IRS tax form 1095-A from most recent federal tax return.
You may be temporarily classified as a California resident for up to one
year, but will need to provide evidence of intent to establish California
residency at the end of the one year waiting period to maintain your
residency status.
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SOLANO COMMUNITY COLLEGE SUPPLEMENTAL RESIDENCY QUESTIONNAIRE (UNDER 19) (Solano Community College)

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Completed 25 July 2020

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