OFFICE OF THE REGISTRAR
Doc Bryan 153
A
PPLICATION FOR
I
N
-S
TATE
R
ESIDENCY
Student I.D. Number
T
Date
Name Enrolled Under (Last, First, Middle, Other) Marital Status
Phone Number
( ) –
Permanent Address (Street, City, State, Zip)
Date of Birth (MM/DD/YYYY)
_ _ / _ _ / _ _ _ _
ddress of Spouse (if applicable) or Parent/Guardian (if under the a
e of 21) if different than
yours
Email Address
A student should be classified as an in-state resident for tuition purposes only if his or her legal residence is located in
Arkansas for all purposes, and by good faith acts the student demonstrates the intent to make Arkansas his or her permanent
home. Legal residence in Arkansas is required for at least six (6) consecutive months immediately preceding the first date of
the semester for which in-state classification is requested. Mere physical presence in Arkansas is not sufficient to
establish residency or demonstrate intent. You may visit http://www.atu.edu/registrar/residency.php for more information.
In order to be eligible for classification as an in-state resident (and be charged the in-state tuition rate), you must meet at
least one of the criteria below. Check all that apply; supporting documentation will be required for each item checked
(see page two for required documentation):
I am a legal resident of a state which is contiguous to Arkansas (Louisiana, Mississippi, Missouri, Oklahoma, Tennessee,
or Texas);
I am married to a legal resident of the state of Arkansas;
I am under the age of 21 and my parent/legal guardian is a legal resident of the state of Arkansas (neither mere physical
presence, or mere ownership of property, in Arkansas is sufficient to establish residency but will be taken into
consideration along with other relevant factors);
I am 21 years of age or older, married, or the parent of a minor child), have lived in the state of Arkansas for at least six (6)
consecutive months immediately preceding the first date of the semester for which in-state classification is requested, and
by good faith acts have demonstrated my intent to make Arkansas my permanent home by providing proof of a primary
residence in Arkansas, Arkansas Personal Property/Real Estate/State Income taxes, Arkansas registered vehicle, and
registering to vote in the state of Arkansas, etc;
I, or my parent/guardian or spouse, am a member of the U.S military with the state of Arkansas or a state contiguous to
Arkansas (Louisiana, Mississippi, Missouri, Oklahoma, Tennessee, or Texas) indicated on my/their Leave and Earning
Statement (LES).
Applicant’s statement justifying in-state classification request—provide any and all relevant rationale for why your request
should be approved (must be completed, or your application cannot be considered). Attach additional pages if necessary.
By signing this applicatio
n, I attest that all information/documentation provided is complete, true and correct.
Student’s Signature: Date:
R
EGISTRAR
’
S
O
FFICE
U
SE
O
NLY
:
Student classified as: In-State
Out-of-State Term:
Phone
In Person
Fax
Email
Registrar’s Office Representative: Date:
Revised June 12, 2018
Applicant notified by:
