Application For Iowa Resident Classification Form
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1
2APPLICATION FOR IOWA RESIDENT CLASSIFICATION
*Notice: This form is used by the Iowa College Student Aid Commission to determine eligibility for state-funded scholarship and
grant programs. This form is NOT used to determine a student’s residency for the purpose of tuition charges at postsecondary
institutions.
The Iowa College Student Aid Commission (ICSAC) requests this information to determine your residence classification. If you fail to
provide the required information, the Commission may not act on this application. Return this form to your school’s financial aid office.
If you have always been a resident of Iowa and have never established domicile in another state, please contact the financial aid office at
the college you are/will be attending for further instructions.
The following section must be filled out completely. If any item in this section is left blank it will cause your application to be denied.
1. Full Legal Name:
Last
First
Middle
2. Social Security Number
3. Date of Birth:
(mm/dd/yy)
4. For what semester or term are you applying for residency?
(mm/yy)
5. What Iowa college/university will you be attending?
6. Where were you born? (City, State)
7. Date you moved (or returned) to Iowa
(mm/dd/yy)
8. If former Iowa resident, when did you leave?
(mm/yy)
Why did you leave Iowa?
9. Reason for coming to Iowa
10. Who moved to Iowa with you? _________________________________________________________________
11. Briefly explain your activities since you arrived in Iowa (Jobs, etc.-Give exact dates).
12. Describe your sources of financial support (job, spouse, parents, etc).
13. Gender:
M
F
14. Independent or Dependent student as determined by FAFSA: _________________
15. Parents state of legal residence (only applicable if a dependent student): __________________________
16. Current Address:
Number and Street (or Rural Route)
City
State
Zip Code
17. Do you:
Rent your home?
Own your home?
18. Permanent Home Address
Number and Street (or Rural Route)
City
State
Zip Code
19. When/where have you attended college in Iowa in the past (if at all)?
College: _________________________ Dates attended: _________________ Credit Hours: ____|____|____
Fall
Spring Summer
College: _________________________ Dates attended: _________________ Credit Hours: ____|____|____
Fall
Spring Summer
College: _________________________ Dates attended: _________________ Credit Hours: ____|____|____
Fall
Spring Summer
20. How long do you intend to live in Iowa? _________________________________________________________
2015
21. If married, give full name of husband or wife
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