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SOLANO COMMUNITY COLLEGE SUPPLEMENTAL RESIDENCY QUESTIONNAIRE (Solano Community College)

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SOLANO COMMUNITY COLLEGE
SUPPLEMENTAL RESIDENCY QUESTIONNAIRE
Students may be required to complete a supplemental residency questionnaire to clarify residency or apply for residency
reclassification. Residency changes are not automatic. To be considered for California residency, you must:
1) Be physically present in California for at least one year and one day prior to the start of the quarter.
2) Show documentation of intent to establish California residency.
3) Not be precluded from establishing residency by provisions of the Immigration and Nationality Act.
Name:
Student ID:
Last First Middle
Phone:
Physical Presence
Permanent address:
Street City State Zip Code
On what date did your current stay in California begin?
Have you resided at the address above continuously for the last two years?
Yes No*
*If you answered “No”, please list addresses for the past two years:
Street City State
Dates
Street City State
Dates
In the last year, have you:
Registered to vote or voted in a state other than California?
Petitioned for a divorce as a resident of another state?
Attended an out-of-state institution as a resident of that state?
Declared non-residence for California income tax purposes?
Yes No
Yes No
Yes No
Yes No
If you answered “yes” to any of the questions above, please give a brief explanation:
Do you possess a state driver’s license or identification card?
Do you have current motor vehicle registration?
Do you have an active California bank account?
Were you employed in California in the past year?
Yes No
Yes No
Yes No
Yes No
State: _______ Date Issued: ____________
State: _______ Date Issued: ____________
Date Opened: _______________________
Are you a U.S. Citizen?
Yes No*
*If you are not a U.S. Citizen, what is your immigration status?
Permanent Resident Temporary Resident/Amnesty Refugee/Asylee Visa holder – type: ________ Other
*Since entering the U.S., have you applied for Permanent Resident status, Asylum, Temporary
Protected Status, Family Unity Program, legalization or been granted a change of visa status?
Yes No
n
a
n
c
i
a
l
Verified by:______
____ CA Resident
____ Nonresident
DOB: ______________
Email: ______________________________
Documentation
Activity/Documentation Type
Date Issued/Begun
California State Income Tax Return (with valid CA address)/Federal Income Tax Return
(with valid CA address) California 540 tax form is 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 ID card
Automobile or other insurance showing a California physical address
Documentation of having received CA 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
Petition for divorce as a California resident
Jury duty summons for a California court
Petition for divorce as a California resident
Do you qualify for any of the following categories? If so, please request the Special Consideration form for details.
• Foster youth or former foster youth age 24 or less
• Member of the military or dependent (child/spouse) on active duty or maintaining domicile in California or remaining in California after discharge
• Full-time employee (or dependent) of a CA State agency assigned to work outside of California or employee of CCC, CSU, UC, or CA 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
• Self-supporting minor or minor under the care and control of individuals other than a parent/guardian for the past two years
Did your parent(s) claim you as a dependent exemption for tax purposes?
Did your parent(s) give you more than $750 per year in financial assistance?
Did you live with your parent(s) for more than six weeks per year?
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
If you answered “yes” to any of the questions above, please list the place of residence of your parents:
Father: __________________________________________ Mother: _______________________________________________
Please attach items that document your residency. The burden of proof is on the student to clearly demonstrate both
physical presence in California 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 identified with the student’s name and physical address.
Status of Financial Independence (ECS 68044, T5 54032)
This Year
In the Prior 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 my 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.
AB 540 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.
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. You must be 24 years or less to qualify.
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 OR 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 purposes. 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.
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.
Graduate of a school in California operated by the United
States Bureau of Indian Affairs
If you graduated from a school operated by the U.S. Bureau of
Indian Affairs that is located in California, please provide a copy of
your diploma.
Employee (or the spouse or c
hild 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 SCC police academy training courses
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.
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:
1. Copy of your credential or emergency permit
2. Statement from your employer that you are employed in a full-
time position requiring certification qualifications
Other exceptions (limitations apply):
Two Year Care & Control
Adult Dependent Child
Minor Remaining in CA
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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Completed 25 July 2020

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