2277 Napa-Vallejo Highway, Napa CA 94558
(707) 256-7200 www.napavalley.edu (707) 256-7219
Dear Napa Valley College Student:
Your request for California Residency will be processed within 24 48 hours during normal business
hours.
If you have already registered for classes this semester please note that you will still need to make
arrangements to pay your in-state California tuition and other mandatory fees within the 7 day Pay-
to-Stay window after you have registered. If you were charged out-of-state tuition fees prior to
submitting your request, we will notify the Business Office of your status so that any outstanding
fees can be adjusted if necessary. You may also log into your Web Advisor account to view your
current account balance(s).
If you have not registered for the current semester then you will need to log-in to your Web
Advisor account in order to register for your classes. If you are unsure of how to obtain your
Username and password, please click on the link: http://tinyurl.com/ztnbvo3 for instructions. If you
need to reset your password, please be sure that your email address is current.
If you have any additional questions, please contact the Welcome Center at (707) 256-7215.
Thank you,
Welcome Center
Admissions & Records
LAST NAME __________________________________________ FIRST NAME _______________________________________ MI ________
AD
DRESS ___________________________________________________________________________________________________________
(Number, Street, and Apartment, if applicable) City State Zip Code
PHONE # _____________________ DATE OF BIRTH ______________ EMAIL _____________________________________________
When did your PRESENT stay in California BEGIN? ______________/___________/______________
Month Day Year
If you lived outside of the state of California, list the states, dates and the parent/guardian with whom you resided before your present stay
in California began:
___________________________________________________________________________________________________________________
State Dates Parent/Guardian
Citizenship Status
U.S. Citizen
Permanent Resident (must list card number and date issued)
Number: __________________________ Date Issued: ______________/___________/____________
Month Day Year
Temporary Resident
Visa (type): _______________________ Country of Issue: _____________________________________________
(If you have applied for a change of status from a Visa that cannot establish residency to a Visa that can establish residency,
you may not be classified as a resident until the Visa has been granted (proof required).
Note: Immigration documentation may be required in order to process any changes in residency regarding permanent resident status.
(Examples include Notice of Action, Employment Authorization documents, etc.)
List the STATE that you have the following:
Driver’s License or Identification Card: _____________(state) Date Issued: ______________/___________/_____________
Month Day Year
Vehicle Registration: _______________(state and date) Voter Registration #: _________________ (State)
Are you UNMARRIED and UNDER 19 years of age? Yes No
Are you declared as a DEPENDENT on your parent(s) state income tax return? Yes No
I reside with one or both of my parents and he/she/they have lived continuously at the following California address: _____________________
__________________________________________ Since: _______________________ Parent/Guardian Name: _________________________
If you have not been claimed as a DEPENDENT list the STATE and YEAR of the last 2 personal Income Tax Returns you filed
State: ________________ Year: _______________ State: ______________ Year: _______________
If NO taxes were filed, please explain: ______________________________________________________________________________________
Are you an ACTIVE duty military member? Yes No Were you discharged? Yes No
Are you a DEPENDENT of an active military person? Yes No
NOTE: If you are on ACTIVE duty orders, please attach a copy of your permanent change of station orders.
I DECLARE UNDER PENALTY OF PERJURY, THAT THE STATEMENTS SUBMITTED ON THIS RESIDENCE STATEMENT AND APPLICATION FOR
ADMISSION ARE CORRECT, and I also understand that falsification, withholding pertinent data or failure to report changes in residence, may
result in my dismissal from Napa Valley College.
Student’s Signature _______________________________ Date ___________________
Admissions and Records
2277 Napa-Vallejo Highway, Napa, Ca. 94558
707.256.
7200 fax 707.256-7219
Statement of Legal Residence
NVC Student ID#
PRINT ALL INFORMATION CLEARLY Information that is deemed relevant and necessary to determine your residency status for tuition purposes pursuant to Education code
Section 68041. This form is to be completed and returned with documentation proving residency. Failure to answer all questions may cause your classification consideration to
be that
of a non-resident. For further information pertaining to residency, please refer to the college website at http://www.napavalley.edu
.
FALL SPRING SUMMER YEAR: _______
(Please indicate which semester/year you are applying for)
For Office Use Only
Approved Denied
Assistant Registrar, Admissions and Records
Res Code: __________Term: __________
Date Processed: ____________________
Comment
:
Establishing California Residency
Eligibility
The following information is extracted from California Education Code sections 68000-68062 and
California Code of Regulations, Title V, 54000-54072. This is provided as a guideline for residency
determination.
Under California law, a person who is married or 18 years of age or older may establish residency
if the person is:
1. A U.S. citizen, permanent resident or hold a valid Visa which allows them to establish
residency and
2. Has lived in California continuously for at least one year and one day, and can prove that
they intend to make California his/her permanent home.
Undocumented students who have attended three years of high school in California and graduated
from a California high school, may be eligible for California residency status under AB540. A
separate form is needed for this exemption.
Documentation
All documentation must show current intent and at least one year and one day of physical
presence in California for residency determination.
Two forms of documentation are needed to determine residency and must accompany the form
when submitting. Documents accepted but are not limited too:
California State Income Tax return (with valid California address)/ Federal Income Tax
Return (with valid California address) (California return is preferred)
California Driver’s License or Identification Card
California voter registration card dated at least a year and a day prior
Ownership of residential property or continuous occupancy in a rented/leased property in
California (proof required)
Recent high school transcript or other California college transcript showing enrollment
Documentation of a student as a California resident having received rehabilitation,
unemployment, welfare, or other state services (proof required)
California vehicle registration (must be dated a year and a day prior to term beginning)
Selective Service registration with a California permanent address
Active California bank account for one year prior to residence determination date
Military Personnel and Dependents
Military personnel stationed on active duty in California are exempt from non-resident tuition for the
duration of their attendance at Napa Valley College as long as they remain in active duty status.
A student who has been discharged from the U.S. armed forces and was stationed in California on
active duty for more than one year prior to discharge, shall receive California residency as long as
they continue to live in the state and intend to make California their home. A copy of the DD214 is
needed for consideration of residency classification.
Dependent students of active duty military members shall be entitled to California resident
classification as long as the member of the U.S. armed forces is on active duty and stationed in
California.
Rev. 3/25/2014