Fillable Undocumented Students Living in Rhode Island Residency Application (Community College of Rhode Island)

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Undocumented Students Living in Rhode Island Residency Application (Community College of Rhode Island)

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Return to Rob Giovino – rgiovino@ccri.edu – 401-825-2288
CCRI Office of Enrollment Services Knight Campus, 400 East Avenue, Warwick, RI 02886-1807
Office of Enrollment Services
Undocumented Students Living in Rhode Island – Residency Application Checklist
If you are not a U.S. citizen, a permanent resident of the U.S., or do not have an eligible non-immigrant visa, you may qualify to
attend CCRI as an in-state resident as an undocumented student living in Rhode Island.
Please submit this along with all required forms and documents. (Please use your legal last and first name)
Last Name___________________________________________________ First Name____________________________
CCRI ID ________________________________________ (if available) Phone_________________________________
CHECK ITEMS SUBMITTED
______Application for Enrollment/Paper (if not yet submitted an application)
______Transcripts for Undocumented Students
(High School seniors submit unofficial high school transcript, which includes mid-year senior grades)
Final Official Transcript with Graduation Date Confirmed
______High School transcript (attended R.I.HS 3 years required) or (U.S. GED® Credentials, 3 years proof of RI residency is required)
______Student Application form (Eligibility for in-state tuition and fees based upon Rhode Island High School Attendance or GED)
______Affidavit form (To be completed by student, signed in the presence of a Notary Public)
______Residency Document for Undocumented Students form
(High School Graduates – one current residency document within the last 90 days)
(GED Graduates – one current residency document – for the past 3 consecutive years)
ADDITIONAL ITEMS NEEDED
DACA STUDENT
______Copy of Employment Authorization Card with category C33 designation – (front and back)
(Active non-expired date as of the first day of classes)
______Copy of Taxpayer ID Number (SSN or ITIN) and Signed Request for Student’s Taxpayer Identification Number (W9S) form.
NON-DACA STUDENT
______Copy of Passport/Visa or Employment Authorization Card – (front and back)
______Copy of Taxpayer ID Number (SSN or ITIN) and Signed Request for Student’s Taxpayer Identification Number (W9S) form.
______If has no SSN or ITIN - Signed Request for Student’s Taxpayer Identification Number (W9S) form.
IF Eligible
______Application for the RI Promise Scholarship ______RI Promise Appeal if over 18 years old _____Paper FAFSA
Apply online at www.ccri.edu/oes/admissions/learnhowtoapply.html
or follow the instructions below to apply by mail.
In Lincoln:
CCRI-Flanagan Campus
Oce of Enrollment Services
1762 Louisquisset Pike
Lincoln, RI 02865-4585
Personal data section
• Your Social Security number and date of birth are essential in processing your application. Your
Social Security number is mandatory under federal law.
• If applying without a social security number, please see http://www.ccri.edu/oes/admissions/
applicantwithoutssnortin.html
• Please note that if you are not a U.S. citizen, you may be asked to submit immigration
documentation as listed on the Application for Enrollment. Foreign students must contact the
Oce of Enrollment Services regarding visas and additional admissions documentation which
is required for attendance at the college.
• Questions pertaining to ethnicity and race are optional; however, answering these questions is
important in assisting the college in its armative action goals
Programs of interest section
• For campus codes and program names, refer to pages 2 through 4 of this application packet.
High school history section
• For high school codes, refer to page 5 of this packet. It is the applicant’s responsibility to provide the
Oce of Enrollment Services with ocial transcripts. Contact your high school guidance department
or GED
®
testing center to forward ocial transcripts or GED
®
scores to the college.
College history section
• List ALL colleges and universities previously attended, whether or not you wish to receive transfer credit.
For your convenience, some college codes are listed on page 5 of this packet. If your institution is not listed,
do not enter a college code on the application.
COMMUNITY COLLEGE OF RHODE ISLAND
Application for Enrollment and Instructions
In Warwick:
CCRI-Knight Campus
Oce of Enrollment Services
400 East Ave.
Warwick, RI 02886-1807
In Providence:
CCRI-Liston Campus
Oce of Enrollment Services
One Hilton St.
Providence, RI 02905-2304
In Newport:
CCRI-Newport County Campus
Oce of Enrollment Services
One John H. Chafee Blvd.
Newport, RI 02840
Degree and Certicate Programs*
COMMUNITY COLLEGE OF RHODE ISLAND
CCRI APPLICATION INSTRUCTIONS / PAGE 2 OF 7 8
/
2013
KN=Knight Campus
FL=Flanagan Campus
PV=Providence Campus
NE=Newport County Campus
A.A.=Associate in Art
A.S.=Associate in Science
A.A.S.=Associate in Applied Science
A.F.A.=Associate in Fine Arts
A.A.S.T.S.=Associate in Applied Science
in Technical Studies
^ Some, but not all, major courses offered
on this campus.
PROGRAM CODE DEGREE CAMPUS DAY EVENING
ADMINISTRATIVE OFFICE TECHNOLOGY
Administrative Assistant/Secretary ADAD A.S. KN FL + +
Basic Ofce Skills Certicate BOSC Certicate KN FL + +
Customer Service Specialist Certicate CSPC Certicate KN FL + +
Legal Administrative Assistant/Secretary LGAD A.S. FL + +
Legal Ofce Assistant Certicate LOAC Certicate FL + +
Medical Administrative Assistant/Secretary MDAD A.S. KN +
Medical Insurance Billing Specialist Certicate MIBC Certicate KN + +
Medical Transcription Certicate MEDT Certicate KN +
Ofce Administration Certicate OFAC Certicate KN FL + +
BIOTECHNOLOGY
Biotechnology Certicate BIOT Certicate KN + +
BUSINESS ADMINISTRATION
Accounting ACCT A.S. KN FL + +
Accounting Certicate ACTC Certicate KN FL + +
Entrepreneurship Certicate ETRC Certicate KN FL + +
Financial Services FNBK A.S. KN FL + +
Financial Services Certicate FNSC Certicate KN FL + +
General Business GBUS A.S. KN FL PV NE + +
Management MNGT A.S. KN FL + +
Management Certicate MGTC Certicate KN FL + +
Marketing MARK A.S. KN FL + +
Marketing Certicate MRKC Certicate KN FL + +
CHEMISTRY
Chemical Technology CHMT A.A.S. KN + +
Chemical Technology Certicate CHMC Certicate KN + +
COMMUNICATION
New Media Communication Certicate NMCC Certicate KN FL PV NE + +
COMPUTER STUDIES and
INFORMATION PROCESSING
Computer Programming CPRD A.S. KN + +
Computer Programming Certicate CPCT Certicate KN + +
Cybersecurity CYBR A.S. PV KN FL NE + +
General Information Processing CMGD A.S. KN + +
General Information Processing Certicate CMGC Certicate KN + +
Information Technology Support Specialist CMSD A.S. KN + +
Information Technology Support Specialist Certicate CMSC Certicate KN + +
Networking CMND A.S. KN + +
Networking Certicate CMNC Certicate KN + +
Ofce Automation Certicate OFFA Certicate KN + +
Web Technologies CWTD A.S. KN + +
Web Technologies Certicate CWTC Certicate KN + +
Degree and Certicate Programs*
COMMUNITY COLLEGE OF RHODE ISLAND
CCRI APPLICATION INSTRUCTIONS / PAGE 3 OF 7 8
/
2013
PROGRAM CODE DEGREE CAMPUS DAY EVENING
ENGINEERING and TECHNOLOGY
CNC Manufacturing and 3D-Modeling Certicate ETCA Certicate KN + +
Introduction to CNC Manufacturing Certifcate ETCI Certicate KN + +
Computer and Networking Technology CNTD A.A.S. KN + +
Computer Desktop Technology Track CDTO A.A.S. KN + +
Computer Networking Technology Track CNTO A.A.S. KN + +
Computer Desktop Technician Certicate CDTC Certicate KN + +
Networking Technician Certicate NWTC Certicate KN + +
Advanced Networking Technician Certicate NWAC Certicate KN + +
Energy Utility Technology Certicate ETUT Certicate KN + +
Engineering Systems Technology ETST A.S. KN + +
CNC Manufacturing Track ETCT A.S. KN + +
Electrical Track ETET A.S. KN + +
Energy Track ETPT A.S. KN + +
Mechanical Track ETMT A.S. KN + +
Engineering Transfer ENGN A.S. KN + +
Biomedical Track ENBI A.S. KN + +
Chemical Track ENCH A.S. KN + +
Chem-Biology Track ENCB A.S. KN + +
Civil Track ENCI A.S. KN + +
Computer Track ENCM A.S. KN + +
Electrical Track ENEL A.S. KN + +
Industrial Track ENIN A.S. KN + +
Mechanical Track ENME A.S. KN + +
Ocean Track ENOC A.S. KN + +
FINE ARTS
Art ARTS A.F.A. PV KN FL NE + +
Theatre THEA
Performance Track DRAM A.F.A. KN FL +
Technical Track TDRA A.F.A. KN FL +
Music
Jazz Studies Track JAZZ A.F.A. KN +
Music Track MUSC A.F.A. KN +
GENERAL STUDIES
General Studies GENS A.A. PV KN FL NE + +
HEALTH SCIENCES
ALLIED HEALTH PROGRAMS
Diagnostic Medical Sonography DMSD A.A.S. FL + +
Histotechnician HSTO A.A.S. PV + +
Magnetic Resonance Imaging Certicate MRIC Certicate FL + +
Medical Laboratory Technology CLAB A.A.S. FL +
Phlebotomy Certicate PHLE Certicate PV + +
Radiography (X-ray) XRAY A.A.S. FL +
Renal Dialysis Technology Certicate RENL Certicate PV +
Respiratory Therapy RESP A.A.S. FL +
DENTAL HEALTH PROGRAMS
Dental Assisting Certicate DAST Certicate FL +
Dental Hygiene DHYG A.A.S. FL +
EMERGENCY/DISASTER MANAGEMENT
Degree and Certicate Programs*
COMMUNITY COLLEGE OF RHODE ISLAND
CCRI APPLICATION INSTRUCTIONS / PAGE 4 OF 7 8
/
2013
*Programs are subject to change at any time.
Emergency Management/Homeland Security EMGD A.S. KN FL PV NE +
Emergency/Disaster Management Certicate EMER Certicate KN FL PV NE +
Fire Science/Emergency Medical Technician FIRE A.A.S. KN FL PV NE + +
Homeland Security Certicate HMLS Certicate KN FL + +
NURSING PROGRAMS
Nursing
(Previous curriculum for students enrolled prior to Fall 2016) NURS A.S. or Diploma KN PV FL NE + +
Nursing
(NEW curriculum for students enrolled in Fall 2016 and after) NURS A.S. or Diploma KN PV FL NE + +
Health Care Interpreter Certicate INTC Certicate PV +
REHABILITATIVE HEALTH PROGRAMS
Occupational Therapy Assistant OCTA A.A.S. NE +
Opticianry OPTI A.A.S. DL/NE +
Physical Therapist Assistant PHTA A.A.S. NE +
Therapeutic Massage TMSG A.A.S. NE +
Therapeutic Massage Certicate TMSC Certicate NE +
HOSPITALITY
Culinary Arts Assistant Certicate CULN Certicate FL + +
Hospitality Certicate HOSP Certicate KN, FL + +
Travel and Tourism Certicate TRVL Certicate KN, FL + +
HUMAN SERVICES
Early Childhood Education and Child Development CHLD A.A. PV KN FL +
Developmental Disabilities Certicate 173 CDVD Certicate KN FL +
Early Childhood Education Certicate 174 CHLC Certicate PV KN FL +
Education/Special Education ESPE A.A. KN FL +
Gerontology Certicate GERN Certicate KN PV FL NE + +
Social Service Majors:
Gerontology GERN A.A. KN FL +
Mental Health MNTL A.A. PV KN FL +
Social Work SOWK A.A. PV KN FL +
Substance Abuse SUBS A.A. KN FL +
Social Services Certicate CSOS Certicate PV KN FL +
LEGAL STUDIES
Law Enforcement LENF A.S. PV KN FL NE^ + +
Paralegal Studies PALG A.S. PV KN FL NE^ + +
LIBERAL ARTS
Liberal Arts LIBA A.A. PV KN FL NE + +
Liberal Arts – English LAEN A.A. KN FL + +
Liberal Arts – Foreign Languages LAFL A.A. KN FL + +
Liberal Arts – Mathematics LAMA A.A. KN FL + +
SCIENCE
Science SCID A.S. KN FL + +
TECHNICAL STUDIES
Technical Studies TECH A.A.S.-T.S. KN FL + +
PROGRAM CODE DEGREE CAMPUS DAY EVENING
PROGRAM CODE DEGREE CAMPUS DAY EVENING
High School and College Codes
COMMUNITY COLLEGE OF RHODE ISLAND
High School Codes
Academy for Career Exploration .....................................................400146
(formerly Textron Chamber of Commerce Academy)
Alternate Learning Project.................................................................400143
Dr. Jorge Alvarez High School ..........................................................400001
Apponaug Christian Academy ...........................................................400241
Aquidneck Island Christian Academy ..............................................400129
Attleboro High School ........................................................................220073
Barrington Christian Academy..........................................................400002
Barrington High School ......................................................................400000
Beacon Charter School ......................................................................400282
Bellingham Memorial Jr.-Sr. High School ........................................220117
Bishop Connolly Regional High School ...........................................220783
Bishop Feehan High School ...............................................................220077
Bishop Hendricken High School .......................................................400238
Bishop Keough Regional High School .............................................400099
Blackstone Academy Charter School ..............................................400100
Blackstone-Millville Regional High School ......................................220160
Blackstone Valley Baptist Academy .................................................400038
Blackstone Valley Reg. Voc. Tech. High School ............................222154
Block Island High School ....................................................................400005
Burrillville High School .......................................................................400055
Case High School .................................................................................222105
Central Falls High School ...................................................................400012
Central High School ............................................................................400145
Chariho High School ...........................................................................400270
Classical High School ..........................................................................400150
Convent of the Sacred Heart ............................................................409001
Coventry High School.........................................................................400030
Coyle-Cassidy Memorial High School ............................................222120
Cranston High School East ................................................................400035
Cranston High School West .............................................................400036
Cumberland High School ...................................................................400037
Davies Career and Technical High School .....................................400057
Dighton-Rehoboth Regional High School .....................................221645
Durfee High School ............................................................................220785
E 3 Academy .........................................................................................400157
East Greenwich High School ........................................................... 400040
East Providence High School ........................................................... 400050
Elmhurst Academy ............................................................................. 409003
Exeter-West Greenwich
Regional Jr.-Sr. High School .........................................................400252
Feinstein High School ..........................................................................400154
First Baptist Christian School ............................................................400242
Fletcher Preparatory ..........................................................................409004
Foxborough High School ..................................................................220840
GED
®
credentials ..................................................................................409999
Global Learning Public Charter School...........................................221488
Greene School ......................................................................................400254
Highlander Charter School ................................................................ 400243
Hope High School ..............................................................................400155
Immaculate Conception Academy ...................................................400227
Johnston High School .........................................................................400058
Killingly High School ............................................................................070135
King Phillip Regional High School ....................................................222562
La Salle Academy ................................................................................400160
Lincoln High School ...........................................................................400059
Lincoln School (Providence) ............................................................400165
Manseld High School .........................................................................221320
Masters Regional Academy ................................................................400220
The Metropolitan Regional Career
and Technical Center .....................................................................400166
Middletown High School ...................................................................400063
Milton High School ..............................................................................221440
Moses Brown School ..........................................................................400180
Mount Hope High School
(formerly Bristol High School) ...........................................................400010
Mount Pleasant High School ..............................................................400185
Mount St. Charles Academy ..............................................................400285
Narragansett High School ..................................................................400064
New England Academy of Torah (Hebrew Day)..........................400187
New England Laborers’/Cranston Public School
Construction Academy ..................................................................400034
North Attleboro High School ...........................................................221625
North Kingstown High School..........................................................400088
North Providence High School .......................................................400090
North Smitheld High School ...........................................................400287
Norton High School ............................................................................221670
Ocean Tides School ............................................................................400066
Our Lady of Fatima High School .....................................................400236
Paul Cuffee High School .....................................................................400006
Pilgrim High School .............................................................................400239
Plaineld High School ..........................................................................070090
Ponaganset High School .....................................................................400093
Portsmouth Abbey School .................................................................400130
Portsmouth High School ....................................................................400128
Paul J. Primavera Educational Center ...............................................220116
The Prout School .................................................................................400228
Providence Career and Technical High School ............................400142
Providence Country Day School ....................................................400045
Rhode Island Nurses Institute Middle College ............................400141
Rhode Island School for the Deaf ....................................................400189
Rocky Hill School .................................................................................400043
Rogers High School .............................................................................400075
Juanita Sanchez Complex ...................................................................400183
(formerly the Providence Academy of International Studies and
William Cooley Health, Science and Technology Academy)
School One ............................................................................................400188
Scituate Jr.-Sr. High School ................................................................400095
Seekonk High School ..........................................................................221891
Shea High School (Pawtucket West) ...............................................400125
Smitheld High School ........................................................................400053
South Kingstown High School...........................................................400230
St. Andrew’s High School .................................................................400250
St. Dunstan’s Day School ...................................................................400193
St. George’s High School ...................................................................400085
St. Mary Academy (Bay View) ...........................................................400215
St. Raphael Academy ...........................................................................400110
Taunton High School ..........................................................................222123
Times 2 Academy.................................................................................400144
Tiverton High School ..........................................................................400224
Tri-County Reg. Voc. Technical High School ................................220864
Trinity Academy for the Peforming Arts .........................................400210
Trinity Christian Academy .................................................................400060
Toll Gate High School.........................................................................400237
Tolman Senior High School ...............................................................400115
U.S. Naval Academy Prep School .....................................................400068
Uxbridge High School .........................................................................222155
Jacqueline M. Walsh School of
Performing and Visual Arts ...........................................................400969
Warren High School ...........................................................................400235
Warwick Veterans High School .......................................................400240
West Warwick High School ..............................................................400265
Westerly High School .........................................................................400255
The Wheeler School ...........................................................................400170
Woonsocket High School ..................................................................400295
Other ......................................................................................................409666
Out-of-Country ....................................................................................409777
Out-of-State (if not listed above) ........................................................409888
COLLEGE CODES
Bridgewater State University ................................................................. 3517
Bristol Community College .................................................................. 3110
Bryant University ..................................................................................... 3095
Community College of Rhode Island .................................................. 3733
Dean College ............................................................................................ 3352
Fisher College ........................................................................................... 3391
Johnson & Wales University .................................................................. 3465
New England Institute of Technology ................................................. 0339
Providence College .................................................................................. 3693
Rhode Island College .............................................................................. 3724
Roger Williams University ..................................................................... 3729
Salve Regina University .......................................................................... 3759
University of Massachusetts-Dartmouth ............................................ 3786
University of Rhode Island .................................................................... 3919
CCRI APPLICATION INSTRUCTIONS / PAGE 5 OF 7 8
/
2013
APPLICATION FOR ENROLLMENT
Tell us about your interest in CCRI. Please share this information with us so that we can better advise you on your best course of action at CCRI.
First time in college. I have not attended college previously.
Returning. I previously attended CCRI.
Nondegree. I am enrolled at another college or university, taking classes at CCRI, but not pursuing a degree at CCRI; or I am interested in taking
courses for personal or professional reasons.
Transfer. I am entering CCRI and I have previous college-level coursework.
Personal data: Complete this form after you have reviewed our program listings. Please print clearly.
Previous name
Permanent home street address
Are you a U.S. citizen?
Yes
No
If you are not a U.S. citizen, do you have a Permanent Resident Card (Green Card)?
Yes
No
If you are a permanent resident card holder, please provide your alien registration number.: _____________________________________________________
Have you lived continuously in Rhode Island for one or more years as of the rst day of classes for this semester?
Yes
No
Is Rhode Island your legal and permanent state of residence?
Yes
No
If you have a non-Rhode Island permanent home address and you are claiming Rhode Island residency, you must submit a CCRI Application for In-State Residency and all
required documentation. This information is available at wwww.ccri.edu/oes/admissions/pdfs/resusperm.pdf
If you are not a legal and permanent resident of Rhode Island, please list your legal residence.
Street
_______________________________________________________City _________________________________________State _______ ZIP _____________ Country____________________________
Are you a recipient of the Supplemental Nutrition Assistance Program (SNAP)?
Yes
No
Service members or dependents
Did you serve or are you serving in the U.S. armed forces?
Yes
No
N/A
If you or your dependents are currently serving, are you stationed in Rhode Island on active duty?
Yes
No
N/A
Will you be using VA education benets at CCRI?
Yes
No
N/A
Will you be using VA education benets as a dependent at CCRI?
Yes
No
N/A
Did you honorably serve in a combat zone?
Yes
No
N/A
Please note:
• Applicants in Refugee Status, Temporary Protected Status, or Political Asylum Status must mail a copy of the documentation of their status.
• Other visa or immigration status: Please mail a copy of your Visa, I-797 or other documentation.
Misrepresentation concerning residency and/or citizenship is grounds for immediate dismissal from the college, but you will rem
ain liable for all tuition and fees.
Date of birth (mm/dd/yy)
Home telephone number
Social Security number
Gender
:
Cell number
Please text me important college information regarding enrollment,
nancial aid and other key milestones in my academic progress
Date of application
City
(as it appears on Social Security card or U.S. passport)
Email address
State/Zip
Last name
First name
Middle initial
Middle initial
The following information helps us comply with federal statistical reporting requirements only and will not, in any way, impact an admission
decision on your application. Federal regulations require colleges to report enrollment data by racial, ethnic and gender categories.
Ethnicity: (Not used for admission. Please check one.)*
Not Hispanic
Hispanic or Latino
Federal regulations require colleges
to report enrollment data by racial, ethnic
and gender categories
Race: (Not used for admission. You may check more than one race.)
American Indian or Native American
Asian
Black or African American
Important information:
One or both parents (biological or adoptive) earned a four-year degree
Yes
No
Single parent with custody of a child under 18
Yes
No
Speaker of English as a second language
Yes
No
Displaced homemaker
†
Yes
No
* Ethnicity/Race data reporting for federal purposes has changed. The selections that you see in this section are the choices as mandated by the federal government for higher education
reporting purposes. Only statistical numbers are reported. No individual data appears on the federal reports.
†
Thetermdisplacedhomemakerreferstowomenormenwhohaveworkedmainlyinthehomeforaminimumoftwoyearscaringforhomeandfamily.Duetolossoffamilynancial
support (usually through death, disability or divorce), these individuals must leave the home and seek to support themselves and their families.
For Oce Use
CCRI ID Number: ForOceUse
Native Hawaiian or Pacic Islander
White
Social Security number is mandatory under federal law. If applying without a social
security number see http://www.ccri.edu/oes/admissions/applicantwithoutssnortin.html
Yes
No
College/University name Code City State Degree
College/University name Code City State Degree
College/University name Code City State Degree
Programs of interest: Please indicate your program choices. Please print clearly.
What program of study are you interested in pursuing?
I am interested in a degree program
1st choice ________________________ ______________________________________________________________________________
2nd choice ________________________ ______________________________________________________________________________
At this time, I am interested in applying as a nondegree student
(Please note: Financial aid, including on-campus work programs, is not available to nondegree students.)
Are you interested in receiving information about the Joint Admissions Agreement (JAA) among the Community College of Rhode Island, Rhode Island College
and the University of Rhode Island?
Yes
No, thank you
Campus
Program of study name
Campus
Program of study name
Year
High school history: Please complete as appropriate. Please print clearly.
I have or will have:
High school diploma
Institution name, city, state
GED
®
credential
State in which GED
®
credential was received
Home school diploma — Please submit documentation from your local school district
approving your home schooling program.
Institution name, city, state
I do not hold any of the above.
Code
Please forward a copy of your nal ocial high school transcript or GED
®
credential to the Oce of Enrollment Services as soon as available.
Diploma Date
Month / Day / Year
College history: Please list ALL undergraduate colleges and universities attended. (Please submit ocial transcripts from each
school to the Oce of Enrollment Services, 1762 Louisquisset Pike, Lincoln, RI 02865.) Please print clearly.
COLLEGE 1:
COLLEGE 3:
COLLEGE 2:
_______________________________________________________________________________ ______________________________________________________ _________________ ________________________
Agreements:
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 fulll all nancial obligations to, the Community College of Rhode Island
.
Acceptance Checkbox
I understand that checking this box constitutes a legal signature conrming that I acknowledge and agree to the above Terms of Acceptance.
For Oce Use Only
NEBHE __________________
Code
Date Received
Month / Day / Year
Code
Date Received
Month / Day / Year
Intended Entry Date
January/Spring
September/Fall
Summer
CCRI APPLICATION 12
/
2018
Applicant's signature Application date
Do you have a bachelor’s degree from a U.S. college or its equivalent from a school in another country?
Yes
No
If yes, indicate the degree received below.
_______________________________________________________________________________ ______________________________________________________ _________________ ________________________
_______________________________________________________________________________ ______________________________________________________ _________________ ________________________
If under age 18, signature of parent/guardian Application date
Please type your First and Last Name
Flanagan Campus,1762 Louisquisset Pike, Lincoln, RI 02865-4585 P: 401-825-2003 F: 401-333-7122
Knight Campus, 400 East Ave., Warwick, RI 02886-1807 P: 401-825-2003 F: 401-825-2394
Liston Campus, One Hilton St., Providence, RI 02905-2304 P: 401-825-2003 F: 401-455-6181
Newport County Campus, One John H. Chafee Blvd. Newport, RI 02840 P: 401-825-2003 F: 401-851-1627
Office of Enrollment Services
Transcripts for Undocumented Students
Last name______________________________________________ First name___________________________________
Address_________________________________City________________________State_______ZIP code_____________
Birth date: Month____________Day___________Year_____________
CCRI ID#_________________________________________ Phone number_____________________________________
Please check one:
_____High School seniors submit unofficial high school transcript, which includes mid-year senior grades.
_____Official sealed high school transcript with graduation date. (Rhode Island high school attendance, three years)
_____Official sealed GED® credentials (three years proof of Rhode Island residency is required.)
_____Official sealed transcript. National External Diploma Program (NEDP) (three years proof of Rhode Island residency is required.)
Community College of Rhode Island locations
COMMUNITY COLLEGE OF RHODE ISLAND
Eligibility for In-State Tuition and Fees Based Upon Rhode Island High School Attendance
Student Application
(To be completed by Student)
If you wish to apply for in-state tuition based upon Rhode Island high school attendance and graduation or a General
Equivalency Diploma (GED), you must complete and submit this application and the attached affidavit. You must also
collect and submit documentation to show that you meet the requirements for receiving in-state tuition and fees.
Please read these materials carefully and consult the attached affidavit and the Guidance for Students and Families for
further information. You must complete both sides of this form, the application and the affidavit.
Prior to filing this application and affidavit, it is recommended that you seek legal guidance if you have any questions
regarding your present immigration status; the possible legal and/or immigration ramifications that may arise from
your filing of this application; and/or your execution of this affidavit.
NAME: CCRI STUDENT ID # IF AVAILABLE:
AGE: DATE OF BIRTH: Gender: Male Female
PLACE OF BIRTH: CITY: STATE: COUNTRY:
CURRENT STREET ADDRESS:
CITY: STATE: ZIP CODE:
TELEPHONE: CELL: EMAIL:
HIGH SCHOOL OR GED INFORMATION (PROVIDE INFORMATION ON ALL SCHOOL[S] YOU ATTENDED IN GRADES 9-12)
SCHOOL NAME
CITY
STATE
FROM (MONTH/YEAR) -- TO (MONTH/YEAR)
For office use only
CCRI STUDENT ID #: Comments:
Received:
Decision Date:
Year: Term Code:
Signature:
COMMUNITY COLLEGE OF RHODE ISLAND
Eligibility for In-State Tuition and Fees Based Upon Rhode Island High School Attendance
Affidavit
(To be completed by student, signed in the presence of a Notary Public, and submitted to the Office of Enrollment
Services – Knight Campus, Warwick )
I, the undersigned under oath, depose and say as follows:
(a) That I have personal knowledge of the facts stated herein, which are all true and correct; and
(b) That I currently live in the state of Rhode Island and have attached documents that demonstrate my residence,
which include several forms of proof such as a rental agreement, property tax bill, car registration, utility bill, an
official piece of mail, or an ID card that lists my address;
(c) That I have lived in Rhode Island for three (3) or more years, have attended an approved high school in the state
of Rhode Island for three (3) or more years, and I hold an official high school diploma (or will hold at the time of
my enrollment) OR that I have lived in Rhode Island for three (3) or more years and have earned a GED (senior
high school equivalency diploma from the state of Rhode Island), or will have earned one by the time of my
enrollment. I have submitted my official high school transcript or GED equivalency transcript as proof;
(d) That I have filed an application for lawful United States of America immigration status, evidence of which I have
attached hereto and incorporated herein, OR that I will file an application for lawful immigration status as soon
as I become eligible to do so. I understand that my failure to file an application for lawful immigration status as
soon as I become eligible to do so will result in a forfeiture of in-state tuition rates for me in the future; and
(e) That I do not, and if I am unemancipated my parent(s) does not, hold a temporary immigration classification or
other immigration status within the definition of “non-immigrant alien” as described in U.S.C §1101(a)(15).
(Please see Guidance for Students and Families for further information on this clause.)
Name (please print your name)
Signature Date
CCRI Student Identification # Student Date of Birth
This Affidavit has been subscribed and sworn to before me on this _______day of ___________, 20
Notary Public of the State of Rhode Island
My Commission Expires:
Flanagan Campus,1762 Louisquisset Pike, Lincoln, RI 02865-4585 P: 401-825-2003 F: 401-333-7122
Knight Campus, 400 East Ave., Warwick, RI 02886-1807 P: 401-825-2003 F: 401-825-2394
Liston Campus, One Hilton St., Providence, RI 02905-2304 P: 401-825-2003 F: 401-455-6181
Newport County Campus, One John H. Chafee Blvd. Newport, RI 02840 P: 401-825-2003 F: 401-851-1627
Office of Enrollment Services
Residency Document for Undocumented Students
Last name______________________________________________ First name__________________________________
Address_________________________________City________________________State_______ZIP code_____________
Birth date: Month____________Day___________Year_____________
CCRI ID#_________________________________________ Phone number_____________________________________
Residency documents accepted
Please check one:
_____Rental agreement
_____Property tax bill
_____Car registration
_____Utility bill
_____Identification card with current address listed
_____Federal income tax return- most recent tax year or a copy of R.I. state income tax return for most recent year
_____Automobile insurance policy
____ An official piece of mail (with your name) that includes the address listed on your Application for Enrollment.
NOTE:
RI High School attendance three years–RI/HS Graduate – one current residency document within the last 90 days.
GED Graduates – one current residency document for the past 3 consecutive years
NEDP Graduates – one current residency document for the past 3 consecutive years
Community College of Rhode Island locations
Instructions
Purpose. The Community College of Rhode Island (CCRI) must get your correct identifying
number to file Form 1098-T, Tuition Statement, with the IRS and to furnish a statement to you.
This will be your Social Security number (SSN) or, if you are not eligible to obtain an SSN, your
individual taxpayer identification number (ITIN). Form 1098-T contains information about
qualified tuition and related expenses to help determine whether you, or the person who can
claim you as a dependent, may take either the tuition and fees deduction or claim an education
credit to reduce Federal income tax. For more information, see IRS Pub. 970, Tax Benefits for
Higher Education.
Under federal law, you are required to provide the requested formation.
Part I.
Enter your name and mailing address. The name should match that used by the Social
Security Administration or Internal Revenue Service.
Taxpayer identification number. Enter your SSN or ITIN. If you do not have an SSN or ITIN,
apply for one and fill out and return this form when you receive it.
Part II.
Sign your name in the space provided to confirm the information provided. The Office of
Enrollment Services cannot change your records without your signature.
Part III.
Please fill out this part only if you are unwilling or unable to provide a taxpayer identification
number. Check either the first or the second box and sign the statement. By law, CCRI must
ask you at least once a year for your taxpayer identification number in order to meet its
obligation to file Form 1098-T.
Deliver or mail the completed form to the address provided. Do not email the form. Email
is not a secure way to transmit personal information.
Penalties
Failure to furnish correct SSN. If you fail to furnish your correct SSN or ITIN to CCRI, the IRS
may impose a penalty of $50 unless your failure is due to reasonable cause and not to willful
neglect.
Misuse of SSNs. If CCRI discloses or uses your SSN in violation of Federal law, CCRI
may be
subject to civil and criminal penalties.
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to give your correct SSN or ITIN to
persons who must file information returns with the IRS to report certain information. The IRS
uses the numbers for identification purposes and to help verify the accuracy of your tax return.
The IRS may also provide this information to the Department of Justice for civil and criminal
litigation and to cities and states to carry out their tax laws.
October
2014
National Association of College
and Business Officers
Returncompletedsignedform,inpersonorbymail,to:
CommunityCollegeofRhodeIsland
OfficeofEnrollmentServices
400EastAvenue
Warwick,RI02886
NameofStudent
Address
PARTI
Icertifythatthenumbershownonthisformismycorrecttaxpayeridentificationnumber.
PARTII
OR
Iamaforeignnational/nonresidentalien
anddonothaveaSocialSecuritynumberor
individualtaxpayeridentificationnumber.
IdonotplantofileanincometaxreturnintheU.S.
IdonotwishtoprovidemytaxpayeridentificationnumbertoCCRIatthistime.
PARTIII IunderstandthatImaybesubjecttoan
IRSfineof$50forfailuretodoso.
IfurtherunderstandthattheIRSwillnotbeabletousetheForm1098‐TfiledbyCCRI
toconfirmmyeligibilityforcertaineducationtaxbenefitswithoutmytaxpayer
identificationnumber.
TaxpayerIdentificationNumber
RequestforStudent’sTaxpayerIdentificationNumber
(SubstituteFormW‐9S)
Signature Date
DateSignature
(SSNorITIN)
_________‐______‐____________ ___________________________
Donotsubmit
thisformtotheIRS
CCRIBannerID
Office of Enrollment Services
CCRI: Application for the Rhode Island Promise Scholarship for 2020 HS/GED graduates
CCRI ID_________________________________________________________
The Rhode Island Promise Scholarship allows 2020 Rhode Island high school graduates to pursue an
associate degree at CCRI tuition free. It appears that you may be qualified to receive this scholarship.
To verify your eligibility for the Rhode Island Promise and to ensure that you understand the criteria
required to be part of this program, you must complete this form.
By my signature below, I attest that I have read and understand the information set out above and the
criteria required to be awarded and to continue to receive the Rhode Island Promise Scholarship.
____________________________________________ ____________
Student’s Signature (Parent’s signature required if student is under 18 years of age) Date
____________________________________________ ____________
Parent’s Signature (Parent’s signature required if student is under 18 years of age) Date
I, (print your name here):_______________________________________, have applied to an associate degree program
at the Community College of Rhode Island and I attest to meeting the following criteria to be considered for the
Rhode Island Promise Scholarship (please initial each line below):
I am a Rhode Island resident, and believe I qualify for in-state tuition and fees pursuant to the Council
on Postsecondary Education’s Residency Policy:
https://www.riopc.edu/static/photos/2017/02/24/S5_residency_050615.pdf
I am, or will be, a 2020 high school graduate (public, private or homeschooled) or a 2020 GED recipient
I was, or will be, younger than 19 years of age when I earn(ed) my high school diploma or GED
OR
I was, or will be, 19, 20 or 21 years of age when I earn(ed) my high school diploma, but believe I should
be considered for this scholarship due to personal circumstances that delayed my HS graduation
I understand that I must also fulfill the requirements below to be granted and receive this scholarship. If I
choose to attend CCRI and receive this scholarship, I hereby understand and certify that I will (please initial
each line below):
Enroll in a CCRI associate degree program in the semester immediately following high school
graduation or the receipt of a high school equivalency diploma.
Complete the FAFSA and all financial aid requirements as applicable
Submit a final official high school transcript or GED transcript
By initialing here, I authorize CCRI to request my transcript directly from my high school
Enroll full-time each semester (fall and spring) for two consecutive years
Earn 30 credits each year (fall, spring, summer). Scholarship guaranteed for fall and spring only.
Maintain a minimum CCRI cumulative GPA of 2.5
Commit, and if I choose to enroll do hereby commit, to live, work, or continue my education in Rhode
Island after graduation from CCRI
I also understand the following policies related to the Rhode Island Promise Scholarship. I understand that
(please initial each line below):
This scholarship is a two-year scholarship.
Students are strongly encouraged to enroll in 15 credits per semester in order to stay on track to earn
30 credits each year. Students may enroll in 12-14 credits per semester, but will then need to enroll in
summer courses, which will not be funded by this scholarship.
Students who withdraw from all courses or stop attending classes during a semester will be subject
to the Federal Financial Aid Title IV refund policy if applicable.
The RI Promise Scholarship will also be governed by the policies and procedures adopted by the
Council on Postsecondary Education.
Disbursement of funds for initial and/or renewal scholarship awards is conditioned upon the state’s
annual approval and appropriation of sufficient funding for the Rhode Island Promise Scholarship
Program.
CCRI: Application for the Rhode Island Promise Scholarship for 2020 HS/GED graduates
Supplemental application form for 19, 20 and 21 year old high school graduates
CCRI ID_________________________________________________________
The Rhode Island Promise Scholarship allows 2020 Rhode Island high school graduates who are under age 19
at the time of graduation to pursue an associate degree at CCRI tuition free. This scholarship may also be
awarded to students who graduate from high school at age 19, 20 or 21 due to personal circumstances that
delayed their high school graduation. You noted on your Rhode Island Promise application that you were, or
will be age 19, 20 or 21 upon high school graduation. This supplemental application is required in order for
CCRI to determine your eligibility for the Rhode Island Promise scholarship.
CCRI will review the personal circumstances noted above and may request further documentation or details
to determine whether or not you are eligible for the Rhode Island Promise Scholarship.
Submitted by:
____________________________________________
Student’s Signature (Parent’s signature required if student is under 18 years of age)
____________
Date
I, (print your name here):_______________________________________, was or will
be 19, 20 or 21 years of age upon completion of my high school diploma, but believe I
should be considered for this scholarship due to personal circumstances that delayed my
high school graduation. Those circumstances were:
I started kindergarten later than other children
I repeated one or more grades of K-12 schooling
I had an IEP or other special education plan that extended my time to graduation
Other personal circumstances, please explain:
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
Financial Aid Office
FINANCIAL AID INFORMATION
Undocumented students are not eligible for federal and most state financial aid
programs. However, undocumented students may qualify for Rhode Island Promise if
they meet all other eligibility requirements. Rhode Island Promise applicants are all
required to file the Free Application for Federal Student Aid (FAFSA). If you meet the
criteria of an “Undocumented Student Living in Rhode Island”, you should fill out a
paper FAFSA.
PLEASE NOTE
If a student does not have a social security number:
The online FAFSA is no longer an option for submission of the FAFSA form.
Please fill out the paper FAFSA
https://studentaid.ed.gov/sa/sites/default/files/2020-21-fafsa.pdf
When filling out the paper FAFSA, the section requiring a social security number
should be left blank.
If available, please provide your CCRI student ID number at the top of the
FAFSA form
Please do not complete the online version or mail the paper copy to the federal
processor.
Please submit completed form to the CCRI Financial Aid Office
How to Submit
By Email
faverification@ccri.edu
By Mail
Community College of Rhode Island
Financial Aid Office
400 East Ave
Warwick, RI 02886 11/2019
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Undocumented Students Living in Rhode Island Residency Application (Community College of Rhode Island)

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Completed 4 October 2020

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