WSAC form HB 1079 Revised 19Jun2014
Washington Higher Education Residency
A Washington law determines whether students can be considered residents of Washington eligible to pay in-state
resident tuition rates at public institutions (RCW 28B.15.012). This law was revised in 2003 to allow certain students
attending public colleges and universities to be eligible for resident student tuition rates. In 2014, the state’s financial
aid law was amended so these students are eligible to be considered for need-based state aid (State Need Grant) if they
are attending either public or participating private colleges in Washington (RCW 28B.92.101). For information on
eligibility and the application process for State Need Grant, please visit
To qualify for resident tuition status and/or State Need Grant eligibility, students must complete this
affidavit/declaration/certification if they have met the following conditions:
1. Completed the full senior year of high school and obtained a high school diploma at a Washington public or
private high school or received the equivalent of a diploma;
2. Lived in Washington for at least three calendar years (36 months) immediately prior to receiving the diploma
or its equivalent;
3. Continuously lived in the state of Washington after receiving the diploma or its equivalent and until such time
as the student is admitted to an institution of higher education.
Print full name Date of birth (month/day/year)
Student Identification Number (if applicable)
Relationship to the college or university: Applicant Current Student
Name of high school:
I certify that:
I will file an application to become a permanent resident of the United States as soon as I am eligible to apply. I
am also willing to engage in activities designed to prepare me for citizenship, including citizenship or civics
review courses.
I am a U.S. citizen or permanent resident of the United States.
I certify or declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and
Signature Place (city, state)
Note to the student: Please submit the original copy of this completed affidavit to the admissions office, the registrar,
or the financial aid office of the college or university to which you are applying. Faxed or e-mailed forms, or forms
without an original signature, are not acceptable.
We are temporarily accepting this form via email while our campuses operate remotely.
Please submit the completed form from your CBC student email to
click to sign
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