Fillable Spring Semester: December 1 Fall Semester: August 1 (Utah State University)

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Spring Semester: December 1 Fall Semester: August 1 (Utah State University)

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Application for In-State Tuition Based
Upon Military Service Exceptions
Admissions Office
Taggart Student Center,
Room 102
0160 Old Main Hill
Logan, UT 84322-0160
Phone: 435.797.1079
Fax: 435.797.3708
Email: residency@usu.edu
Application Deadlines
Fall Semester: August 1
Spring Semester: December 1
Instructions
This application should be completed by students trying to qualify for in-state (resident) tuition under
one of the following exceptions:
•
U.S. military service member assigned to active duty within Utah (Includes Utah National Guard and Active
Reserves)
•
Immediate family member of a U.S. military service member currently assigned to active duty within the state
of Utah
•
U.S. military veteran
•
Immediate family member of a U.S. military veteran who has separated within the last five years
•
Eligible person entitled to benefits under 38 U.S.C. Chapter 30, Montgomery G.I. Bill –Active Duty Educational
Assistance Program, or Chapter 33, Post 9/11 Educational Assistance Program
You must take the following steps to apply for in-state (resident) tuition:
•
You must be admitted to Utah State University.
•
You must read these instruction pages and the Board of Regents Policy R512 found
at
https://
higheredutah.org/policies/r512-determination-of-resident-status/.
•
Download, print, complete and sign this application form.
Handwritten signatures are required.
•
Submit your application to resdoc.usu.edu, along with all required documents, on or before the
appropriate semester deadline. If you fax or mail your materials to us, you should follow up to confirm
we received them.
•
Please do not submit tax document through email. It will not be accepted. Due to guidance from the
Department of Education we can no longer accept tax documents via email.
•
If you are unable to submit required documentation, you must provide a written statement, including
your name, A-number and an explanation of why you are unable to provide the documentation. You
should know that providing the written statement does not waive the required documentation.
•
Check your preferred email regularly to be sure you receive any notifications for additional documentation
in a timely manner.
An individual who maintains residency in Utah with an intent to return but who is serving on active
duty in the US Armed Forces and is assigned outside of Utah (includes cases where the student is
a spouse or dependent child.
•
Applicants seeking residency for tuition purposes must submit documentation verifying their eligibility.
These instructions describe documentation required for each residency exception listed below.
U.S. military service member assigned to active duty within Utah (including Utah National Guard
and Active Reserves)
•
Copy of the military orders placing you in Utah on active duty assignment
•
Copy of your current military ID card
Immediate family member of a U.S. military service member currently assigned to active duty
within the state of Utah
•
Copy of the military orders placing the service member in Utah on active duty assignment
•
Copy of the military service member’s military ID card
•
Copy of your military privilege card
U.S. military veteran
•
Copy of Military DD-214, which includes proof of honorable or general discharge
•
Signed written declaration that you have relinquished residency in any other state and do not maintain a
residence elsewhere –found in the signature section of this application
•
Objective evidence that you have demonstrated an intent to establish residency in Utah, which
may include any one of the following:
• Utah voter registration card
•
Utah driver’s license or identification card
• Utah vehicle registration
•
Evidence of employment in Utah
•
Rental agreement showing your name and a Utah address
•
Utility bills showing your name and Utah address
Immediate family member of a U.S. military veteran who has separated within the last five years
•
Copy of military veteran’s DD-214, which includes proof of honorable or general discharge within the last
five years.
•
Signed written declaration that you have relinquished residency in any other state and do not maintain a
residence elsewhere –found in the signature section of this application.
•
If applicant is the dependent child of the U.S. military veteran, a copy of the military service member’s
most recent federal tax return verifying they claimed the applicant as a tax dependent.
•
Objective evidence that you have demonstrated an intent to establish residency in Utah, which
may include any one of the following:
• Utah voter registration card
•
Utah driver’s license or identification card
• Utah vehicle registration
•
Evidence of employment in Utah
•
Rental agreement showing your name and a Utah address
•
Utility bills showing your name and Utah address
Required Documentation
The applicant is required to establish his/her own domiciliary ties once he/she makes the move to
Utah in order to meet other Utah laws that govern driving in the state or operating a vehicle in the
state of Utah, etc.
• Utah voter registration card
•
Utah driver’s license or identification card
• Utah vehicle registration
•
Evidence of employment in Utah
•
Rental agreement showing your name and a Utah address
Eligible person entitled to benefits under 38 U.S.C. Chapter 30, Montgomery G.I. Bill –
Active Duty Educational Assistance
Program, or Chapter 33, Post 9/11 Educational
Assistance Program
Utility bills showing your name and Utah address
If applicant is a dependent child, a copy of the military service member's most recent federal
tax return verifying they claimed the
applicant.
An individual who maintains residency in Utah with an intent to return but who is serving
on active duty in the US Armed Forces and is assigned outside of Utah (includes cases
where the student is a spouse or dependent child):
•
•
•
A copy of the military service member's military identification card (if applicant is a dependent
child or spouse, a copy of the applicant's military privilege card can be submitted instead).
A copy of the military service member's most recent military orders.
Objective evidence that the military service member has not relinquished residency ties to
Utah, which may include any one of the following:
• Utah voter registration card
•
Utah driver’s license or
identification card
• Utah vehicle registration
•
Copy of a Utah income tax return, in the military service member's or a military service member's
spouse's name, filed as a Utah resident
Proof that the military service member or military service member's spouse owns a home in
Utah, including a property tax notice for property owned in Utah.
•
•
•
•
Evidence of eligibility under Title 38 U.S. Code Chapter 30, Montgomery G.I. Gill – Active Duty
Educational Assistance Program, or Chapter 33, Post 9/11 Educational Assistance Program.
Students may obtain verification through the Veteran Resource Office (TSC 314)
Signed written declaration that you will utilize G.I. Bill benefits – found in the signature section
of this application
Objective evidence that you have demonstrated an intent to establish residency in Utah, which may
include
any one of the following:
•
•
Admissions Office
Taggart Student Center, Room 102
0160 Old Main Hill
Logan, UT 84322-0160
Phone: 435.797.1079
Fax: 435.797.3708
Email: residency@usu.edu
Application for In-State Tuition Based
Upon Military Service Exceptions
Application Type Information
Seeking Resident Status
Year
Fall (August)
Spring (January)
Indicate how you are trying to qualify:
U.S. military service member assigned to active duty within Utah (Includes Utah National Guard and Active Reserves)
Immediate family member of a U.S. military service member currently assigned to active duty within the state of Utah
U.S. military veteran
Immediate family member of a U.S. military veteran who has separated within the last five
years
Eligible person entitled to benefits under 38 U.S.C. Chapter 30, Montgomery G.I. Bill – Active Duty Educational Assistance
Program, or Chapter 33, Post 9/11 Educational Assistance Program
Student: Last name
First name Middle name
A-Number
Other names under which your academic records may be listed
Are you a citizen of the
United States?
Yes
No
If no, what is your status?
Permanent Resident Authorized Alien #
Date Issued
(mm/dd/yyyy)
Asylum
Refugee placed directly in Utah
Refugee placed in another state
Temporary Resident
Visa Type
Other
If other, please specify
If you are not a U.S. citizen, attach verification of your status.
You must be a U.S. citizen or have permanent resident, asylum, or
refugee status in order to be eligible for residency for tuition purposes.
Utah resident prior to active duty deployment of self or parent/spouse
Mailing address
City
State
Zipcode
Email
Phone
Date of Birth (mm/dd/yyyy)
Age
Is this your first
residency
application at any
Utah school of
higher
education?
Yes
No
If no, at which Utah school did you
last apply for residency?
Were you granted
residency?
Yes
No
If yes, what term/year were
you granted residency?
Are you a U.S. military service member
assigned to active duty within Utah?
Yes
No
If yes, list dates of military assignment in Utah (mm/dd/yyyy):
From
To
Assignment location
Are you the immediate family member (spouse
or dependent child) of a U.S. military service
member assigned to active duty within Utah?
What is your
relationship to the
service member?
List dates of military assignment in Utah (mm/dd/yyyy):
From
To
Yes
No
If yes, what is the military
service member’s name?
Spouse
Dependent Child
Assignment location
Are you a military veteran that has separated
from military service?
If yes, what date did you separate
from the military? (mm/dd/yyyy)
What type of discharge were you granted?
Yes
No
Which best describes your military service at time of separation:
Full-time active duty in the U.S. Armed Forces, for at least 180 consecutive days, separated or retired with an honorable or
general discharge.
Incurred an actual service related injury or disability in the line of duty regardless of whether you completed 180 days of active
duty.
Member of a reserve component separated or retired with an honorable or general discharge.
Member of the National Guard separated or retired with an honorable or general discharge.
Are you the immediate family member (spouse
or dependent child) of a military veteran?
What is your
relationship to the
veteran?
What date did the military veteran separate from the
military? (mm/dd/yyyy)
Yes
No
If yes, what is the veteran’s
name?
Spouse
Dependent Child
What type of discharge was the military veteran
granted?
Which best describes the veteran’s military service:
Full-time active duty in the U.S. Armed Forces, for at least 180 consecutive days, separated or retired with an honorable or
general discharge.
Incurred an actual service related injury or disability in the line of duty regardless of whether they completed 180 days of active
duty.
Member of a reserve component separated or retired with an honorable or general discharge.
Member of the National Guard separated or retired with an honorable or general discharge.
Are you entitled to benefits under Title 38 U.S. Code Chapter 30,
Montgomery G.I. Bill – Active Duty Educational Assistance Program, or
If yes, do you intend to utilize G.I. Bill benefits?
Chapter 33, Post 9/11 Educational Assistance Program?
Yes
No
Yes
No
What term will you begin using G.I. Bill benefits?
Declaration of Intent to Establish Permanent Residence in Utah
All applicants applying for residency under the exceptions for U.S. military veterans, immediate family members of U.S.
military veterans, or eligible persons entitled to G.I. Bill benefits must sign a declaration of intent to establish permanent
residence in Utah.
I hereby declare that I have abandoned any domicile or residence in any state or commonwealth of the United States of America
other than the State of Utah and I further certify that I have established a bona fide domicile or residence in the State of Utah with
the intent of making Utah my true, final and permanent home and place of habitation, having clearly abandoned any former domicile
or residence and having no intent to make any other location outside the State of Utah my home and habitation.
Signature of Applicant
Date (mm/dd/yyyy)
Declaration of Intent to Utilize G.I. Bill Benefits
All applicants applying for residency under the exception for eligible persons entitled to G.I. Bill benefits must sign a
declaration of intent to utilize those benefits.
I hereby declare that I intend to utilize G.I. Bill benefits
starting with the following term/year:
Signature of Applicant
Date (mm/dd/yyyy)
Declaration of True and Accurate Information
I, the undersigned, declare under penalty of perjury that the information I have provided on this application form is true and
accurate.
I understand that this information will be used to determine my eligibility for residency tuition. I further understand that if
any of the above information is found to be false, I will be liable for payment of all non-resident charges from which I was exempted
and may be subject to disciplinary action by the institution. I also understand that making a false or misleading statement may be
grounds for revoking my residency status and is a Class B misdemeanor punishable pursuant to Utah Code Annotated, Section
76-8-504 or other applicable provisions of the Utah Criminal Code.
Signature of Applicant
Parent or Guardian Signature
(if
applicant is under 18)
Date (mm/dd/yyyy)
Date (mm/dd/yyyy)
Declaration of Applicant Responsibilities
Be aware that by signing below you truthfully acknowledge having read and understood the residency policies and the procedures
for applying for reclassification.
I, the undersigned, declare under penalty of perjury that I have read:
•
The Utah State University Institutional Policy;
•
The Board of Regents Policy R512; and
•
The instruction sheets attached to this application form.
I acknowledge my obligation to submit a complete residency application with all required documents, as outlined in the instructions,
by the appropriate term deadline. I have provided written statements of explanation for any required documentation that has not
been submitted with my application. I understand that such written explanations do not waive the requirement to provide all required
documentation and may, in fact, cause my request for reclassification to be denied.
Signature of Applicant
Parent or Guardian Signature
(if
applicant is under 18)
Date (mm/dd/yyyy)
Date (mm/dd/yyyy)
Updated: 3/15/2019
For Office Use Only
Date Request Received: ______________________
Approved: _________________________________
Denied: ___________________________________
Date of Application Decision: __________________
Notes: ____________________________________
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Spring Semester: December 1 Fall Semester: August 1 (Utah State University)

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Completed 31 August 2020

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