Fillable University of West Florida - Request for AL Differential OOS Tuition Plan

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University of West Florida - Request for AL Differential OOS Tuition Plan

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REQUEST FOR ALABAMA DIFFERENTIAL
OUT-OF-STATE TUTITION PLAN
Phone: 850-474-2244
residencyreclass@uwf.edu
Revised: 07142017
The University of West Florida has been authorized to offer residents of Alabama a special out-of-state tuition rate.
Qualification is based upon documented evidence of legal residence in the State of Alabama for at least 12 months prior to the first day
of classes of your semester of review. Additional documentation (i.e. employment verification, residential verification, copies of legal
ties, etc.) other than what is specifically listed below may be required. The deadline for submission of this request form is the first
day of classes for the semester of qualification. All required supporting documentation must be submitted prior to the
published last day of drop/add for the semester of qualification.
Last Name
First Name
UWFID
Term/Year for which you wish to be considered
UWF email
I CERTIFY THAT I AM:
I am a United States citizen, permanent resident alien or legal alien granted indefinite stay by the United States Immigration and
Naturalization Service (INS). I meet the Alabama residency requirements to qualify for differential tuition fees based on one of the
following criteria:
I am an independent person (a person who provides more than fifty (50) percent of his/her own support as defined by the
Internal Revenue Service) and have maintained legal residence in Alabama for at least twelve (12) months, OR, I am
married to an independent person, who has maintained legal residence in Alabama for at least twelve (12) months.
REQUIRED: For those claiming residency via spouse, you must provide a copy of the marriage certificate.
I am a dependent person (a person for whom fifty (50) percent or more of his/her support is provided by another as defined
by the Internal Revenue Service) whose parent or legal guardian has maintained legal residence in Alabama for at least
twelve (12) months. For dependents, the claimant is the parent/legal guardian.
REQUIRED: Copy of current IRS returns (Federal and State) for parent/legal guardian.
I am a member of the armed services of the United States and I am stationed within Alabama on active military duty
pursuant to military orders, OR whose state of legal residence is Alabama, OR I am a member’s spouse or dependent child.
REQUIRED: Copy of military orders, or DD-2058 (showing city and state of legal residence); for spouse, also provide a
copy of the marriage certificate; for dependent child, also provide a copy of current IRS returns (Federal and State) for
parent/legal guardian.
According to the United State Immigration and Naturalization Service (INS), I am a permanent resident alien or other
legal alien granted indefinite stay and have established and maintained legal residence in Alabama for at least twelve (12)
months. REQUIRED: INS documentation and proof of residency status.
REQUEST FOR ALABAMA DIFFERENTIAL
OUT-OF-STATE TUTITION PLAN
Phone: 850-474-2244
residencyreclass@uwf.edu
Revised: 07142017
Person claiming residency must complete all sections below in full
• IF YOU ARE A DEPENDENT STUDENT, YOUR PARENT/GUARDIAN IS THE CLAIMANT FOR RESIDENCY
• IF YOU ARE AN INDEPENDENT STUDENT, YOU ARE THE CLAIMANT FOR RESIDENCY
• IF YOU ARE MARRIED AND CLAIMING THROUGH A SPOUSE, YOU ARE CONSIDERED INDEPENDENT, BUT
YOUR SPOUSE IS THE CLAIMANT
Please Print:
Date claimant began establishing legal Alabama residence and domicile:
/
/
Mo
Day
Yr
Claimant’s Relationship to student:
Claimant’s Permanent Legal Address:
Street/P.O. Box Apt No. City State Zip Code
Claimant’s Telephone Number:
Claimant’s Voter Registration:
State:
Number:
County:
Original Issue Date:
/
/
Claimant’s Driver License/State Id:
State:
Number:
Original Issue Date:
/
/
Claimant’s Vehicle Registration:
State:
Tag Number:
Original Issue Date:
/
/
Non-U.S. Citizen Only:
Resident Alien Number:
Number:
Copy of both sides of card are required
Original Issue Date:
/
/
Please provide any other documentation not listed above that supports your request for resident status in the state of
Alabama. i.e. employment verification, residential verification, copies of legal ties, etc.
I do hereby swear or affirm that the above named student meets all requirements indicted in the checked category above for
classification as a Florida resident for tuition purposes. I understand that a false statement in this affidavit will subject me to penalties
for making a false statement pursuant to 837.06, Florida Statutes, and to the Board of Governors, 7.005
.
Signature of person claiming Alabama residency
Date
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University of West Florida - Request for AL Differential OOS Tuition Plan

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Completed 23 April 2020

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