Return form to UIW Office of Financial Assistance
Texas Higher Education Coordinating Board Rule 21.25 requires students to complete a set of questions
confirming residency before state funds can be disbursed.
Name: Student ID:
City: State: Zip Code:
Phone Number: Email:
Questions for Residency and High School Completion
Did you (or will you) graduate from a high school, complete home-
schooling, or complete a GED in Texas?
Did you live (or will you have lived) in Texas for 36 consecutive months
prior to high school graduation or GED completion?
Prior to beginning classes at UIW, did you (or will you have) live(d) in
Texas for 12 consecutive months?
Are you a U.S. Citizen or Permanent Resident?
Is one of your parents an active duty member of the U.S. Military?
If yes to the above, is Texas listed as your parent’s official Home of
Record on their Leave and Earnings Statement?
Certification of Residency
I understand that officials of UIW will use the information submitted on this form to determine my
status for residency eligibility. I authorize the university to verify the information I have provided. I
agree to inform UIW of any changes in the information provided and certify that the information on this
form is complete and accurate. I understand that the submission of false information is grounds for
cancellation of any state funds offered and/or received.
Student Signature: Date:
University of the Incarnate Word
Office of Financial Assistance
Basic Texas Residency Questionnaire
4301 Broadway, Box 308
San Antonio, TX 78209
Phone: (210) 829-6008
Fax: (210) 283-5053