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You are petitioning to amend the residency rate (Las Positas College)

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1
You are petitioning to amend the residency rate determined by the data you entered on your new application or to notify
the college of a change to your former status. According to Title 5 section 54024, among acceptable evidence of intent to
establish California residence includes but is not limited to:
1. Ownership of principal residence property or continuous occupancy of
rented or leased property in California.
2. Registering to vote and voting in California.
3. Licensing from California for professional practices.
4. Active membership in services or social clubs.
5. Showing California as home address on federal income tax form.
6. Payment of California state income tax as a resident.
7. Possessing California motor vehicle license plate.
8. Possessing a California driver’s license.
9. Establishing and maintaining active California bank accounts.
10. Being the petitioner for a divorce in California.
11. Maintaining permanent military address or home of record in California with the armed forces.
According to Title 5 section 54024, conduct inconsistent with a claim of California residence includes but is not limited to:
1. Maintaining voter registration and voting in another state.
2. Being the petitioner for a divorce in another state.
3. Attending an out-of-state institution as a resident of that other state.
4. Declaring non-residence in California for state income tax purposes.
If your citizenship/immigration status needs to be clarified, you will be asked to enter the title of the documentation you
are submitting as evidence of the immigrant status that allows you to establish California residency. Non U.S. Citizen
documentation to prove immigration status may be such things as:
1. Passport/Visa type
2. Permanent resident card I-551/Greencard.
3. Proof of original file date I-130, I-94, Letter from filing attorney.
4. I-688 or I-688A Employment Authorization Card.
Special Considerations for DACA students who will submit or have submitted the Dream Application:
If you are a DACA student who will submit or who has submitted the Dream Application, we also recommend that you
submit the following additional documentation:
1. Proof of either:
• Having attended a combination of California high school, adult school, and community college for the
equivalent of three (3) years or more.
• Having three (3) or more years of California high school coursework and attended a combination of
California elementary, secondary, and high school of three (3) years or more.
2. Proof of completion:
• Graduated with a California high school diploma or have the equivalent (i.e., California-issued GED,
CHSPE).
• Completed an Associate’s degree from a California Community College.
• Completed the minimum requirements at a California Community College for transfer to the California
State University or the University of California.
Please complete pages 2 through 4, attach required documentation, and submit via private and secure student Zonemail
email during the Covid-10 pandemic office closure in-person at the Admissions and Records Office (Building 1600, Room
1670, 2nd Floor). You will be notified via email once your petition has been processed.
Rev. PL; na / rb / mpb up 8.14.2020
PETITION FOR CORRECTION OR RECLASSIFICATION FROM NONRESIDENT OR
FOREIGN STUDENT TUITION STATUS TO CALIFORNIA RESIDENT
Attach 2 (minimum) documents that
contain the following:
• Your name
• California address
• Date that is 366 days old
prior
to
first day of semester.
Example: If the term starts on
1/13/2020, the documents must be
dated on or before 1/14/2019.
Rev. PL; na / rb / mpb up 8.14.2020 2
W ID#: _____________________________
Student Name:
The California Education Code Section 68044 requires that the financial independence of a nonresident student seeking reclassification
as a resident be included in the factors to be considered in the determination of residence. In order to establish financial independence,
a student seeking reclassification must meet the following criteria for the current and immediately preceding three calendar years: (1)
the student has not been claimed as an exemption for state and federal tax purposes by his or her nonresident parents, (2) the student
has not received more than $750 from his or her nonresident parents, and (3) the student has not lived in the home of his or her
nonresident parents for more than six weeks in any given year.
Failure to satisfy all of the financial independence criteria for the entire period will not necessarily result in a denial of residency status
if the durational requirement is met and the manifestation of intent is sufficiently strong. Financial independence is of greater
significance for the current and immediately preceding calendar year. Failure to satisfy all three of the financial independence criteria
for the current and immediately preceding calendar year will normally result in a determination of nonresidency. Financial
independence or want of it, for the second and third calendar years immediately preceding the year in which reclassification is requested
will be considered together with all other relevant factors in determining intent with no special weight attached to the financial
independence factor. Therefore, please answer all of the following questions:
1. Indicate your source of financial support in:
2018–present:________________________________________________________________
2018–2017: _________________________________________________________________
2017– 2016: _________________________________________________________________
2. Did or will you file state income tax returns for the year:
2018 Yes No I
yes, list state:______
2017 Yes No I
yes, list state: ______
2016 Yes No
yes, list state: ______
If you answered "yes" for each of these years, please skip questions 3 through 6 and proceed to page 3 after signing this page.
3. Did your parents or will your parents claim you as an exemption on their state and federal income tax returns filed in
the year:
2018 Yes No I
yes, list state:______
2017 Yes No I
yes, list state: ______
2016 Yes No
yes, list state: ______
If you answered "no" for each of these years, please skip questions 4 through 6 and proceed to page 3 after signing this page.
4. Are your parents California residents?
Yes No
Indicate the
state
of residence for each of your parents:
Mother: ___________________________
Father: ___________________________
5. Did you or will you live with your parents for more than six weeks in
:
2018 – present Yes
No
2018 – 2017 Yes
No
2017 – 2016 Yes
No
6. Did you or will you receive more than $750 in financial assistance from your parents in
:
2018 – present Yes
No
2018 – 2017 Yes
No
2017 – 2016 Yes
No
By signing this form, you understand that any misrepresentation of information provided may result in dismissal or disciplinary action in accordance with Student
Disciplinary Action and/or a financial obligation that must be paid in accordance with the processing and collection of tuition and fee payments. Further, you understand
that STATE RESIDENCY CHANGES WILL NOT BE MADE RETROACTIVELY and that the deadline to make a residence change is prior to the start of the enrolled term.
Student Signature: ________________________________ Date: ______________________
Please proceed to the next page.
STUDENT FINANCIAL INDEPENDENCE STATUS
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Rev. PL; na / rb / mpb up 8.14.2020 3
W ID#: _____________________________
Student Name:
RESIDENCE ADDRESS (LEGAL/PERMANENT ADDRESS. DO NOT USE PO BOX NUMBER.)
___________________________________________________________________________________________________________________________
Number & Street City Zip Code
I have lived at this address since ___ ___ / ___ ___ / ___ ___ ___ ___
Month Day Year
If less than two years, show previous addresses below:
_____________________________________________________________________ ___ ___ / ___ ___ ___ ___ to ___ ___ / ___ ___ ___ ___
Number & Street City Zip Code Month Year Month Year
_____________________________________________________________________ ___ ___ / ___ ___ ___ ___ to ___ ___ / ___ ___ ___ ___
Number & Street City Zip Code Month Year Month Year
When did your present stay in California begin? ___ ___ / ___ ___ / ___ ___ ___ ___
Month Day Year
Date of birth ___ ___ / ___ ___ / ___ ___ ___ ___
Month Day Year
PLEASE ANSWER THE FOLLOWING QUESTIONS:
YES NO
1. Are you registered to vote in California? ........................................................................................................................................
2. Do you
maintain voter registration in another state? ....................................................................................................................
3. In the
last two years, did you attend an out-of-state college or university as a resident of that other state? ...........................
4. Do you
pay California state income tax as a resident? ...................................................................................................................
5. In the
last two years, did you pay income tax in another state? ...................................................................................................
6. In the
last two years, were you a petitioner for divorce in another state? ..................................................................................
7. Do you
currently possess a California driver’s license? .................................................................................................................
8. Are yo
u receiving scholarship monies from an agency in another state? ....................................................................................
9. Do you
r parents claim you as a dependent for income tax purposes? .........................................................................................
10. If you
own an automobile, do you possess California motor vehicle license plates? ..................................................................
11. Do you
own residential property or have you continuously occupied rented or leased property in California? ......................
12. Are yo
u licensed from California for professional practice? ..........................................................................................................
13. Do you
maintain active membership in service or social clubs in California? ..............................................................................
14. Are yo
ur spouse, children, or other close relatives present in California? ...................................................................................
15. Do you
show California as your home address on your federal income tax form? .....................................................................
16. Did yo
u maintain California as your permanent military address or home of record while in the
armed forces?
Not Applicable .....................................................................................................................................................
17. Have yo
u established and do you maintain active California bank accounts?
.............................................................................
18. Did you
attend high school in California? (If no, proceed to next page) .......................................................................................
19. Did yo
u obtain a California high school diploma? ..........................................................................................................................
20. How man
y total years did you attend high school in California? ..................................................................................................
_________
Please proceed to the next page.
PETITION FOR RECLASSIFICATION FROM NONRESIDENT
STATUS TO THAT OF CALIFORNIA RESIDENT - Part I
Rev. PL; na / rb / mpb up 8.14.2020 4
W ID#: _______________________________
Student Name:
PETITION FOR RECLASSIFICATION FROM NONRESIDENT STATUS TO THAT OF CALIFORNIA RESIDENT - Part II
Have you previously submitted a Petition for Reclassification? ______ If so, what date? ____________
Have you ever attended Chabot College and/or Las Positas College as a foreign student attending on an F-1 or M-1 student visa? Yes No
If yes, please contact the International Student Admissions Office.
What is your current national status at this time?
Non U.S. Citizen documentation to prove
immigration status may be such things as:
passport, permanent resident card I-551, proof of
original file date, I-130, I-94. I-688 or I-688A
Employment Authorization Card.
U.S. Citizen
Immigrant – Permanent Resident
Temporary Resident (Perm Res pending)
Political Asylum/Refugee Applicant
Visa (indicate type ________________)
Other ___________________________________________________________
Deferred Action for Childhood Arrivals (DACA)
If you are a DACA student who will submit or who has submitted the Dream Application, then please read and sign the following affidavit for non-
citizens without current or valid immigration status:
By signing the signature line below, I hereby state that if I am a non-citizen without a current or valid immigration status, I have filed an
application to legalize my immigration status or will file an application as soon as I am eligible to do so.
Student Signature
____________________________________________
Date:
________________________
If your citizenship/immigration status needs to be clarified, you must provide the following:
1. Documentation that proves your citizenship/immigration status allowing you to establish California residency dating back at least 366 days prior
to the first day of the semester to which you have applied.
2. Two documents (listing your name and CA residence) that prove you have resided in the State of California for at least 366 days prior to the first
day of the semester to which you have applied.
If only your state residence needs to be clarified, you must provide the following:
1. Two documents (listing your name and CA residence) that prove you have resided in the State of California for at least 366 days prior to the first
day of the semester to which you have applied.
NOTE: Failure to submit required documentation will result in a denial of your reclassification petition.
Name of document
Document #
Date of Issuance
Expiration Date
Please state why your documents are evidence you should be classified as a California resident:
I certify under penalty of perjury that the information on Parts I and II of this residence questionnaire is correct and I understand that falsification or
failure to report change in residence may result in my dismissal or disciplinary action in accordance with Student Disciplinary Action and/or a financial
obligation that must be paid in accordance with the processing and collection of tuition and fee payments. Further, I understand that STATE RESIDENCY
CHANGES WILL NOT BE MADE RETROACTIVELY and that the deadline to make a residence change is prior to the start of the enrolled term.
Student Signature _________________________________________ Date ______________ Term ____________
OFFICE USE ONLY
CA Resident (both
qualifications must be
met)
Provided evidence of intent
to permanently reside in CA
at least 1 year prior to term
start
Provided evidence of having
resided in CA for 1 year
prior to term start
Out of State Resident (check reason)
Citizen-Other U.S. State
Noncitizen-Immigrant Visa, hasn’t lived in CA
1 year prior to term start
Noncitizen-Immigrant Visa, intent to
permanently reside in CA document dated
less than 1 yr. prior to term start
No amendment. Out of state code remains.
Nonresident Tuition
Noncitizen-
Nonimmigrant
Visa/Undocumented
No amendment.
Nonresident code
remains.
RESC/RESL REAC/REAL
ABEC/ABEL REDC/REDL
Effective/Denial Term:
Date:
Date Banner amended:
Initials:
SGASTDN:
Student Notified:
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Completed 2 February 2021

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