Residency Reclassification Request Form

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Office of Admissions, Records & Enrollment Development
1501 Mendocino Ave. Santa Rosa, CA 95401
Phone: (707) 527-4685 Fax: (707) 527-4798
Residency Reclassification Request Form
All students are classified as either a resident of the State of California or non-resident when applying for admission. The residency status determines
whether students will be charged non-resident tuition and capital outlay in addition to CA enrollment fees. Residency changes are not automatic. For
more information, see Residency Requirements under ‘A&R Resources’ on the Admissions & Records web page at santarosa.edu.
To be considered a California resident for tuition purposes, you must:
1) Be physically present in California for at least one year and one day prior to the first day of the semester, and
2) Show documentation of intent to establish California residency dating at least one year and one day prior to the first day of the semester
to present, and
3) Not be precluded from establishing residency by provisions of the Immigration and Nationality Act.
 Fall ________  Spring ______  Summer _______
Semester Reclassification requested for (check only one):
Print Full Legal Name: _______________________________________________ Student ID # ____________________________
Birth Date: ______/______/______ Age: _____ Phone: (_______) _________-___________
Address: __________________________________________________________________________________________________
City: _______________________________________________________________State: _____________ Zip Code: ___________
E-Mail Address: ____________________________________________________________________________________________
 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, and
U.S. Citizen
proof of original file date on Notice of Action. Documentation
Immigrant – Permanent Resident
must date back at least 365 days prior to the first day of the
semester in order to be eligible for CA resident status. Status
Temporary Resident
must be able to establish residence. You must provide
Refugee/Asylee
documentation of your citizenship/immigration status.
Visa (indicate type: ______________________________)
Other:
When did your present stay in California begin? _____/_____/_____
Have you lived at your current address for the past two years? Yes ___ No ____ If no, please list your previous
addresses for the past two years:
Address _______________________________City/State: ________________________From: ____/____ To: ____/____
Address_______________________________ City/State: ________________________ From: ____/____ To: ____/____
In The Last Year, Have You:
Registered to vote or voted in a state other than California:
Yes___ No ____
Petitioned for a divorce as a resident of another state?
Yes___ No ____
Attended an out-of-state institution as a resident of that state? Yes ___No ____
Declared non-residence for California income tax purposes?
Yes___ No ____
If you answered yes to any of the questions above, please give a brief explanation:
__________________________________________________________________________________________________

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