Military connected student or dependent of a military connected student. I can submit proof of VA Benets, DD214, dependency status or ocial military
orders. I understand that these documents will be reviewed to determine eligibility for in-state tuition.
My legal, documented and true and permanent home and place of habitation or domicile is (Street, City, State, ZIP Code, Country):
_______________________________________________________________________________________________________________________________________________________________________________
I certify that the information that I have provided on this application is true and correct. Further, by signing this form, I agree to
abide by the rules and regulations at and fulll all nancial obligations to the Community College of Rhode Island.
APPLICATION FOR IN-STATE RESIDENCY
Personal data: Complete this form after you have reviewed our program listings. Please print clearly.
Previous/Maiden Name
Permanent home street address
Have you lived continuously in Rhode Island for one or more years as of the rst day of classes for this semester?
Yes
No
Are you a U.S. citizen or Permanent Resident (Green Card) holder?
Yes
No
Is Rhode Island your legal and permanent state of residence?
Yes
No
Are you in the armed forces (or a dependent) currently stationed in Rhode Island?
Yes
No
If yes, please send a copy of the current military orders with assignment to Rhode Island to the Oce of Enrollment Services.
Will you be using military benets at CCRI?
Yes
No Will you be using military benets as a dependent at CCRI?
Yes
No
Veteran ID number _______________________________________________________ (Veteran ID number is the Social Security number of the veteran benet holder.)
Please note: Misrepresentation concerning residency and/or citizenship is grounds for immediate dismissal from the college and liability for all tuition and fees that may result.
Date of birth (mm/dd/yy)
Home telephone number
CCRI Identication number
Cell number
Email address
Date of application
City
Name as it appears on Social Security card or U.S. passport
ZIP
State
Last name
First name
Middle initial
Last name
First name
Middle initial
Please complete this form to be considered for in-state residency. Failure to complete all sections will result in being
assessed out-of-state status for tuition calculation purposes. Please print clearly.
Have your parents (or legal guardian) claimed you as a dependent on their federal income tax return for the last two years?
Yes
No
A. If answer to the above question is Yes, please supply the corresponding forms of documentation to determine residency status.
A photocopy of your parents’ latest R.I. State Income Tax Return, including parents’ signature.
A signed copy of your parents’ federal income tax return for the most recent year, including parents’ signature.
Your parents’ current rental lease (or utility bills) or evidence of property ownership indicating residency at the address listed on
your CCRI Application for Enrollment showing one year of occupancy.
Both parents’ R.I. driver’s licenses and vehicle registrations with issue dates that are at least one year prior to the rst day of classes
B. If answer to the above question is No, please supply the corresponding forms of documentation to determine residency status.
A signed copy of your federal income tax return for the most recent year.
A current rental lease (or utility bills) covering your residency at the address listed on your CCRI Application for Enrollment showing one year of
occupancy. If formal leases are unavailable, a notarized statement from the landlord detailing dates and remittances maybe substituted.
Your Rhode Island driver’s license and vehicle registration with an issue date that is at least one year prior to the rst days of classes.
If younger than 24, provide copies of your parents’ federal income tax returns for the last two years or a notarized statement from your
parents stating that you were not claimed as a dependent on their federal income tax return for the last two years and they have no intention of such
claim in the future.
Agreement:
For Oce Use Only
In-State
NEBHE
Out-of-State
Signature of Applicant (If under age 18, signature of parent/guardian) Date
Residency Appeal Letter – Rev Jan-19
