Fillable STATEMENT OF LEGAL RESIDENCE A student may request (Cuesta College)

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STATEMENT OF LEGAL RESIDENCE A student may request (Cuesta College)

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ADMISSIONS AND RECORDS OFFICE
Mail: PO Box 8106, San Luis Obispo, CA 93403-8106
Fax: (805) 546-3975, Email: admit@cuesta.edu
A student may request California residence reclassification by completing this Statement of Legal Residence. As of the
Residence Determinate Date, evidence must be provided demonstrating 1)physical presence and 2)intent to make
California legal residence for other than a temporary purpose. The burden of proof lies with the student to clearly
demonstrate both physical presence in California and intent to establish California residence in accordance with California
Education Code, Section 68000 et seq., 68130.5.
TERM SEMESTER BEGINS RESIDENCE DETERMINATION DATE DEADLINE TO SUBMIT REQUEST:
Fall 2019 August 12, 2019 August 11, 2018 August 26, 2019
Spring 2020 January 21, 2020 January 20, 2019 February 3, 2020
Summer 2020 June 15, 2020 June 14, 2019 June 29, 2020
Fall 2020 August 17, 2020 August 16, 2019 August 31, 2020
WARNING: Falsification, withholding pertinent data, or failure to report change in residency may result in District action.
STUDENT’S NAME:_____________________________ CUESTA ID NUMBER: 9___ ___ ___ ___ ___ ___ ___ ___ DOB______________
A
DDRESS: ________________________________ CITY__________________________________ STATE_____ ZIP CODE __________
S
TUDENT’S PHONE: (______)__________________ STUDENT’S E-MAIL __________________________________________________
If currently enrolled, check the term you started attending Cuesta: Spring Summer Fall Year: 20___
What term are you requesting residency for? Spring Summer Fall Year: 20____
PART 1: CHECK ONE OF THE FOLLOWING STATEMENTS BELOW TO DETERMINE RESIDENCY DEPENDENCE.
I am 19 or older and at least one of the statements below is true about me. I am or have been married
I am legally emancipated.
I do not have a living parent or guardian.
As of the day before the first day of the term I am applying for, I am or will be on active duty in the armed services
.
As of the day before the first day of the term I am applying for, I have been self-supporting for at least one year.
If at least one of the bulleted statements above applies to you, continue to Part 2 and 3 and answer for yourself.
If a statement below applies to you, continue to Part 2 and Part 3 and answer for your parent or guardian.
I am 19 or older and claimed as dependent on my parent’s last income tax returns filed in the state of _____________
I am under 19 years of age and unmarried and live with a parent. Parent’s name: ____________________________
I am un
der 19 years of age and unmarried and live with a guardian in Californi
a.
Submit a cop
y of your court-order with this form or a written statement of guardians
hip.
Name of Le
gal Guardian: _______________________________ Phone: _______________________________
I am under 22 years of age and currently under court-ordered Foster Care in California.
Attach a cop
y
of
y
our court-order with this form. Skip Part 2 and 3. Sign and date below.
PART 2: PHYSICAL PRESENCE IN CALIFORNIA AS STATE OF LEGAL RESIDENCE.
Indicate date of continuous presence by you (or parent or guardian) in the state of California except for absences,
which can be explained without conflicting with your residency. Month:______ Day: ______ Year: _______
Do you (or parent or guardian) intend to maintain California as your state of legal residence?
Yes
No
Are yo
u (or parent or guardian) a U.S. Citizen? Yes No
If no, indicate you (or parent/guardian) citizenship status:
Permanent Resident Temporary Resident Amnesty Refugee / Asylee
Alien ID number : _______________________ Issue Date (mm/dd/yyyy): ___________ Exp. Date (mm/dd/yyyy: ___________
Other Visa - Attach a copy. Visa Type: _____ Issue Date (mm/dd/yyyy): ___________ Exp. Date (mm/dd/yyyy: ____________
I DECLARE UNDER PENALTY OF PERJURY THAT THE ABOVE IS TRUE AND CORRECT.
STUDENT’S SIGNATURE: _______________________________________________ DATE: _________________________
STATEMENT OF LEGAL RESIDENCE
✔
PROVISIONS ELIGIBLE FOR NONRESIDENT TUITION EXEMPTION
Review exemptions below you may be eligible and attach supporting documentation. Skip Part 3 if applying for exemption.
I am a full-time employee (or a dependent or spouse of an employee) of the following colleges/universities:
Documentation Required: Statement on letterhead from one of the following schools verifying full-time employment.
California Community College
California State University or College
University of California
Maritime Academy
I am a full-time credentialed employee of a California public school enrolling in college for purposes of fulfilling
credential-related requirements. Documentation Required: 1)Copy of valid credential and 2)Statement on letterhead of
full-time employment by a public school, position requires certification qualifications.
I have been employed as a seasonal agricultural worker for at least a total of two months of each of the past two years.
Documentation Required: Letter from employer verifying months of employment in prior two years.
Eligible exemption: Special Immigrant Visa: ______ September 11 dependent survivor
You will receive a response within 2-3 business days. If more information is needed to determine your residency, we will
email you. If you already registered, your nonresident fees will be reversed once your request is approved. If request is
denied, students may appeal decision to the Director, Outreach & Enrollment Services. Appeals must be submitted within
the term residency reclassification is requested.
TERM SEMESTER BEGINS RESIDENCE DETERMINATION DATE RECLASSIFICATION DEADLINE
Fall 2019 August 12, 2019 August 11, 2018 August 26, 2019
Spring 2020 January 21, 2020 January 20, 2019 February 3, 2020
Summer 2020 June 15, 2020 June 14, 2019 June 29, 2020
Fall 2020 August 17, 2020 August 16, 2019 August 31, 2020
PART 3: EVIDENCE OF INTENT TO MAKE CALIFORNIA THE STUDENT’S PERMANENT HOME
1. You may skip this section if applying for one of the provisions above or are applying as a Foster Youth under
court-orders.
2. Complete below and provide documentation for at least three (3) of the following activities.
3. Your documents must show that you have lived in California as of the Residence Determination Date or
y
ear prior for the term
y
ou are requestin
g
residenc
y
for.
ACTIVITY OF INTENT TO ESTABLISH CALIFORNIA RESIDENCY MONTH YEAR
Ownership of residential property or continuous occupancy of rented or leased property in
California. (Example: Rental or lease agreement.)
Registering to vote and voting in California. (Example: Voter’s registration.)
Licensing from California for professional practice.
Active membership in California professional, religious, merchant, service organizations or social
clubs. (Example: California Lions, or Rotary club member.)
Showing California as home address on federal income tax forms. (Example: W-2, 540, 1040)
Payment of California state income tax as a resident.
Maintaining California motor vehicle license plates/registration.
Maintaining California driver's license or a California ID card.
Establishing and maintaining active California bank accounts. (Example: Bank Statements)
Being the petitioner of divorce in California. (Example: Divorce petition.)
DD 214, Leave and Earnings Statement (LES) while in the armed forces, or your military order.
If a dependent of military member, provide documentation to verify relationship to military member.
Registering for the Selective Service in California (indicating California address.)
OFFICE USE ONLY
Checklist: 1)Age/dependency, 2)Citizenship, 3)Date eligibiilty
US Citizen PR/TR (issue/exp date) + 3 Activities within Res Det Date
Visa Eligible (copy) + 3 Activities within Res Det Date
Foster Youth CA Court Orders (update SVAMIST)
Guardianship Court Order + 3 Activities within Res Det Date
Guardian Statement within Res Det Date + 3 Activities within Res Det Date
VA Dependent verify to military member
Othe
r
/DACA = INELIGIBLE, AB540 eligible?
Processed by: _________________________ Date: ____________
Approved Denied: __________________________________
Term: Spring Summer Fall Year: _____________
Note: Update future term if active (i.e. summer then fall)
SFAREGS R = Resident
Student Notification: In-person US Mail Email
Updated 1.10.2020
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STATEMENT OF LEGAL RESIDENCE A student may request (Cuesta College)

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Completed 4 September 2020

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