Fillable form 1040 that shows the dependents claimed.: RESIDENCY (Walla Walla Community College)

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form 1040 that shows the dependents claimed.: RESIDENCY (Walla Walla Community College)

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RESIDENCY CLASSIFICATION INFORMATION
1) FINANCIALLY INDEPENDENT OR DEPENDENT
The student must provide …
□ A signed copy of their US income tax form 1040 for the last calendar year. If no US income tax return was filed, then
a signed statement as to why the student did not file an US income tax return.
□ If under the age of 25, the student must provide a copy of their parent(s)’s or legal guardian’s most recent US tax
form 1040 that shows the dependents claimed.
□ Verification of year-to-date earnings (a W2 form or if the student or parent did not work, then a statement
explaining such)
NOTE: For financially dependent students, the reverse side of the residence questionnaire needs to be filled out and
signed by the student’s parent/legal guardian and all supporting documentation must be from the parent/legal
guardian.
2) ESTABLISHMENT OF A DOMICILE IN WASHINGTON
The student must prove conclusively that they have established a bona fide domicile in Washington State for reasons
other than education for 12 months prior to the start of the quarter for which they are applying for recognition of
Washington State residency.
If a student (or parent, if student is dependent), has attended a Washington institution for more than six credits per
term anytime during the 12 months in which residency is being established, state law presumes the move to the state
was primarily for educational purposes and the time of enrollment is NOT counted toward the establishment of
residence. Exception can occur if you are able to PROVE otherwise.
In order to prove Washington State residency, please submit as many of the items listed below as possible.
NOTE: All legal drivers must hold a valid Washington State license and submit a copy.
□ Lease/rental agreement, letter from landlord, mortgage settlement
□ Washington driver’s license
□ Washington motor vehicle registration (not title)
□ Washington voter registration card
□ Checking or savings account statements (at least a 12-month timespan, i.e., January 2015 & January 2016)
□ Address listed on selective service registration
□ Receipt of benefits under public assistance programs
□ Hunting or fishing license
In determining whether domicile has been established, no single factor or specific combination of factors guarantees
that domicile has been established.
DEADLINES: The Residence Questionnaire Form and all supporting documentation must be received by the 30
th
calendar
day of the quarter (i.e. Quarter starts on January 4, 2016, need all documentation by February 3, 2016) for which you
are applying for recognition of residency in order to become effective beginning that quarter.
Residency must be established 12 months prior to the start of the quarter for which the student is applying for
recognition of residency.
Send Washington Residence Questionnaire along with all supporting documentation to the
Office of Admissions & Records
admissions@wwcc.edu
| Phone: (509) 527-4283
Washington Residence Questionnaire
Directions: Please print clearly and answer each question. Incomplete or illegible forms cannot be considered and will be returned. Falsification or
intentionally erroneous information is subject to perjury under the laws of the State of Washington, RCW 9A.72.085. All information will be kept
confidential in accordance with the Family Educational Rights and Privacy Act of 1974. Once a domicile is established in Washington, it must continue
for one year before you are eligible for resident tuition.
SECTION 1
Name (Last, First, MI)
Day Phone Number
FOR OFFICE USE ONLY
( )
Type
Address (Street, State, Zip)
Student ID Number
Status
DEP
INDEP
E-mail Address
Birth City, State, Country
Birth Date
Age
Age
Today's Date
1. Last high school attended _________________________________________ State ___________ Year Graduated _____________
Effective Date
2. For what term are you now seeking
residence classification? Year 20___
Fall
Winter
Spring
Summer
If you have previously applied at this institution for a change in residence status, indicate: Term __________ Year __________
Resident
Non-Resident
3. Class Standing: Undergraduate Graduate Professional School: _______________________________________
____________________________________
Residence Classification Officer
4. At this Institution, you are or will be enrolled as a:
New Student
Continuing Student
Returning Former Student
If continuing or former student, give number of credit hours for which you were registered during each of the last three terms and identify each term by session and year:
Credits ______ Term __________ Year __________ | Credits _______ Term __________ Year ___________ | Credits _______ Term __________ Year __________
5. Country of citizenship:
If not USA, answer 5a, 5b and 5c.
Note: An immigrant refugee, and the spouse and dependent children of
such refugee, may be exempted from paying the nonresident tuition fees
differential if the refugee (a) is on parole status, (b) has received an
immigrant visa, or (c) has applied for U.S. citizenship.
6. Have you received financial assistance from a state governmental unit or agency
during the past twelve months?
Yes
No
7. Will you be receiving state financial assistance during the next twelve months?
Yes
No
SECTION 2
1. Are you applying for resident status as a dependent
student whose parent or court -appointed legal guardian
has maintained a bona fide domicile in the State of
Washington for at least one year?
Yes
No
If yes, your parent or legal guardian must complete SECTION 3 of this form, providing proof of his/her
Washington domicile and all requested supporting documentation. Verification of your dependent status
must be documented by submitting a true and correct copy of your parent's or legal guardian's state and
federal income tax return for the most recent tax year. The extent of the disclosure required concerning
the parent's or legal guardian's state and federal tax returns is limited to the listing of dependents claimed
and the signature of the taxpayer and shall not require disclosure of financial information contained in the
returns.
2. Are you applying for resident status as a financially
Independent student?
Yes
No
If yes, you must complete Section 3 of this form and provide all requested supporting documentation.
2a. Student's Sworn Statement:
I have not been and will not be claimed as an exemption for federal Income tax purposes by any person except myself or my spouse for the current calendar year and for the
calendar year immediately prior to the year in which this application is made; and I have not received and will not receive financial assistance in cash or in kind of an amount
equal to or greater than that which would qualify me to be claimed as an exemption for income tax purposes by any person except myself or my spouse during the current
year and for the calendar year immediately prior to the year in which this application is made.
Signature _________________________________________________________________________________________________ Date ___________________________
2b. To further substantiate your financial Independence, you are required to submit appropriate documentation.
A true and correct copy of your state and federal income tax return for the calendar year immediately prior to the year in which this application is made. If you did not file a state or federal
income tax return because of minimal or no taxable income, documented information concerning the receipt of such nontaxable income must be submitted.
A true and correct copy of your W2 form filed for the previous calendar year.
Other documented financial resources. Such other resources may include but are not limited to, the sale of personal or real property, trust fund, state or financial assistance, gifts, or earnings of
the spouse of a married student.
If you are 24 or younger, provide a true and correct copy of the first and signature page of the state and federal tax return of your parents, legally appointed guardians, or person or persons who
have legal custody of you for the calendar year immediately prior to the year in which this application is made. The extent of the disclosure required concerning the parent's or legal guardian's
state and federal tax returns is limited to the listing of dependents claimed and the signature of the taxpayer and shall not require disclosure of financial information contained in the returns.
3. Are you on active duty military stationed in the state of Washington or the spouse or dependent of such a person?
Yes
No
4. Did you spend at least 75% of both your junior & senior years in a Washington state high school, and did you enroll in college within 6 months of leaving high school, and were
your parents/legal guardians domiciled in Washington for at least 1 year within the 5-year period before you graduated from high school?
Yes
No
Directions: Do not leave any questions blank. No decision can be made unless all questions are completed and all required documentation is
submitted.
SECTION 3
1. This section is being completed and signed by:
Parent Legal Guardian Student
Date of your arrival in Washington :
Month: ________ Day _______ Year ______
Purpose of moving to Washington:
Date you took action to officially declare Washington as
your permanent, legal domicile:
Month: ________ Day _______ Year ______
2. List chronologically your employment and physical residence for the last two years giving exact information as requested below. If you were not employed, list your physical residence for
the last two years. Attach additional page if necessary.
DATES OF EMPLOYMENT
LOCATION
OCCUPATION
HOME ADDRESS
Mo. Day Yr.
Mo. Day Yr.
City State
Employer Hrs/wk
Street City State
Note: You must provide proof of your physical presence in Washington the past 12 months (e.g. copies of rent receipts, lease or home purchase agreements, cancelled rent
checks, letter from landlord, letter from employer, etc.).
3. If you were out of Washington during the last 12 months, give dates, and reasons for your absence:
DATES OF ABSENCE
LOCATION
PURPOSE OF ABSENCE
Mo. Day Yr.
Mo. Day Yr.
City State
4. Have you ever
registered to vote?
Yes No
If yes, attach a
copy of your
current voter's
card.
If yes, list date, city and state for your last two registrations.
Date ____________ City __________________________ State ________ Date Voted ____________
Date ____________ City __________________________ State ________ Date Voted ____________
5. Do you own or use any
motor vehicles, RV’s,
boats or mobile homes?
If yes, give type of vehicle, license number, state and dates of registry. You must attach a copy of vehicle registration (not the title).
Type of vehicle ________________________ License Number __________________________ State __________ Date of Registry ___________
Yes No
Type of vehicle ________________________ License Number __________________________ State __________ Date of Registry ___________
6. Do you have a valid
driver's license?
If yes, you must attach
a copy of your current
driver's license.
If yes, in what state:
_________________________
When did you first obtain a driver's license in that state?
Date ______________________________
Yes No
Previous driver's
license?
Yes No
If yes, in what state:
_________________________
When did you first obtain a driver's license in that state?
Date ______________________________
7. Do you have a bank
account?
Yes No
If yes, please attach
documentation of date
you opened account.
If yes, since what date?
_________________________
Name of Bank _______________________ Branch _______________
City ________________________________ State ________________
8. Have you ever paid
in-state tuition at any
public institution of
higher education?
Yes No
If yes, date of last term __________________________________________
Name of Institution _____________________________________________
Dates Attended: From _____________________ To __________________
8a. Have you ever attended a Washington college/university for more than 6
hours per term? Yes No
If yes, where _________________________________________________
Dates attended From____________________ To ___________________
9. Are you a US Citizen?
Yes No
If no, attach a copy of your Resident Alien Card, I-94 or other INS documentation.
10. List business or
professional licenses
(name & state of issue)
______________________________________________________________________________________________________________
Additional Comments:
STATEMENT OF INTENT
I certify that I have declared
Washington as my true, fixed,
and permanent place of
habitation.
Signature of Parent (if completing SECTION 3) _____________________________________________
Date ____________________
CERTIFICATION
Parent Address (Street, City, State)
______________________________________________________________________________
______________________________________________________________________________
I certify under penalty of
perjury under the laws of the
State of Washington, RCW
9A.72.085 that the foregoing
and all supporting
documentation are true and
correct.
Signature of Student _________________________________________________________________
Date _____________________
AG Form #151 – Revised 1/15/02 – AG Approval 4/19/02. Revised by HECB 6/2009, AG approval 6/10/2009, effective 7/01/2009.
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form 1040 that shows the dependents claimed.: RESIDENCY (Walla Walla Community College)

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Completed 27 July 2020

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