License Number ______________________ Date issued _____/_____/_________
: _________ Date: _____/_____/_______
8. List the state and year in which your last two state income tax returns were filed.
State _______ Year _______ State _______ Year _______
Date purchased: _____/_____/_______
10. Do you rent prope
No If yes, lease type (circle one)? 6 month 1 yr. or more Month to month
Beginning date _____/_____/_______ Ending date _____/_____/_______
If “No” to 9 and 10 please explain _______________________________________________________________________
11. Source of financial support for the past year? _____________________________________________________________
12. Were you employed in CA in the past year?
Employer_________________________________________ From: _____/_____/_______ to _____/_____/_______
Your address shown on current W-2_________________________________________________________________
14. Are you claimed as a dependent on the military records of any member of the U. S. armed forces
If yes, explain relationship and answer No. 16 as it pertains to the service person _____________________________
of record on military records __________
Most recent address on military records __________________________________________________
Yes State currently stationed and dates? ________ _____/_____/_____
State date began
16. Student Financial Independence Status. Education Code 68044 requires that the financial independence of a non-resident
student seeking reclassification of a non-resident student seeking reclassification as a resident be included in the factors to be
considered in the determination of residency. Therefore, all students must answer the following questions.
a. Will your parent(s) claim you as a dependent exemption for the state and/or federal tax purposes for the current or
previous calendar years?
b. Have you received or will you receive more than $750 in financial assistance from your parent(s) in the current or
previous calendar years?
c. Have you lived or will you live for more than six weeks with your parent(s) during the current or previous calendar
d. Are your parent(s) CA Residents?
CERTIFICATION TO BE READ AND SIGNED BY ALL STUDENTS COMPLETEING THIS FORM.
I DECLARE UNDER PENALTY OF PERJURY THAT THE STAEMENTS AND DOCUMENTS SUBMITTED BY ME ARE TRUE,
ACCURATE AND CORRECT. I further understand that all materials submitted by me for the purposes of residency
reevaluation become property of Woodland Community College. I understand that falsification, withholding pertinent
data, or failure to report changes in residency may result in my dismissal.
Student signature Parent/Guardian