Minnesota Residency Verification Form
Name (First, Middle, Last)
Permanent Street Address
Phone Number St. Thomas ID Number
Residency: o Yes o No MN Grad/GED o Yes o No ATR Reviewed o Yes o No
o Eligible o Ineligible
8. You must sign this form certifying that the information you are providing is true.
Signature _____________________________________________________________ Date Signed ____________________________________________
1. Provide your high school address (city and state) and the year that you received your high school diploma:
City _____________________________________________ State ______________ Date of high school graduation: ________/________
Month Year
2. Please provide the address at which you resided when you received your high school diploma:
__________________________________________________________________ ______________________________________________________________________
Street Address City State Zip Code
3. If you did not graduate from high school, did you earn your G.E.D.? o No o Yes If yes, in which state? ___________________ Date: ________/________
Month Year
4. Have you (the student) maintained continuous residency in the State of Minnesota since birth? o No o Yes If yes, go to question 6
7. If you are currently residing outside of Minnesota, are you enrolled in a distance education program offered by a Minnesota college?
o No o Yes
5. Please list all of the states (or countries) in which you have resided, including the State of Minnesota, your dates of residence and your reason for residing in each
location (e.g. college, employment, military service, place of birth, etc.). Please indicate if any of the following reasons for residing in Minnesota apply to you or your
spouse: you relocated to MN because your spouse is a MN resident, you/your spouse are serving active federal military service in MN, your spouse is a veteran who is a
MN resident, relocation to MN from presidential disaster area within 12 months of disaster declaration, or immediate relocation to Minnesota as refugee from another
country.
N S/C D R R R L
______________________________ ____________________________ _______________________________________________________________________
______________________________ ____________________________ _______________________________________________________________________
______________________________ ____________________________ _______________________________________________________________________
6. List all graduate/professional schools attended after completion of a bachelor’s degree and the dates of attendance for each school. Include all graduate/professional
institutions even if the credits were not transferable or you were only enrolled at the institution for one term (e.g., summer school, etc.). If you withdrew from college during a
term due to a major illness while under the care of a physician, or you withdrew for active military service after December 31, 2002, please make note of this and provide the
necessary documentation to the Financial Aid Office. Please list all colleges attended, even if you do not wish to transfer credits from that institution.
N G/P S D A
_____________________________________________________________________________________ ________________________________________________
_____________________________________________________________________________________ ________________________________________________
_____________________________________________________________________________________ ________________________________________________
o I have not attended any graduate/professional schools.
To be considered for funding through the Minnesota Office of Higher Education, the Financial Aid Office must verify that you meet
the Minnesota state residence and term limit requirements established by the state legislature. This form is required for all graduate/
professional students and must accompany the grant application.
FINA 1525 9/17
FOR OFFICE USE ONLY
City, State, Zip Code
X
University of St. Thomas
Financial Aid Office - Mail 5007
2115 Summit Avenue
St. Paul, MN 55105-1078
Telephone (651) 962-6550
Fax (651) 962-6599
University of St. Thomas
Graduate Financial Aid Office
Terrence Murphy Hall, Suite 251
1000 LaSalle Avenue
Minneapolis, MN 55403
Scan completed form and e-mail to nancialaid@stthomas.edu
