Residency Reclassification Request Form Page 2

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Documentation of CA Residence
The documents presented must be valid, legible, and cover the one year and one day period before the first day of the semester
(residency determination date). Documents must be properly identified with the student’s name and a corresponding CA address.
The burden of proof is on the student to clearly demonstrate both physical presence in CA and intent to establish a permanent home in
CA. You are required to present evidence in accordance with Ed Code Sections 68040 et seq. The one-year residence period which a
student must meet to be classified as a resident does not begin to run until the student both is present in CA and has manifested clear
intent to become a CA resident. (T5 54028)
You must provide 2 to 3 of the following kinds of documentation from the list below. (If you are under 19 before the first day
of the semester, please provide documentation of your parent’s CA residence.) No item/category may be used more than once.
Please be aware that every case for residency is different based on the individual’s situation; therefore, the Santa Rosa Junior
College Residency Specialist has the right to request additional documentation.
 Documentation of ownership and continuous occupancy of residential property or continuous occupancy of
rented or leased property, in CA, covering the one-year period prior to the Residence Determination Date.
Date Begun ____/____/____
 Documentation of Voter Registration and voting in CA.
Date Issued ____/____/____
 Licensing from CA for professional practice.
Date Issued ____/____/____
 Showing CA as home address on federal income tax return (form 1040) from previous year. Year filed _______
 CA State income tax return filed as a CA resident (Form 540) from previous year coupled with employment pay
stubs dated prior to the determination date of residency. Pay stubs must reflect the student’s employment.
Year filed __________
 Valid CA Motor Vehicle Registration. (Issue date must date back one year plus one day.)
Date Issued ____/____/____
 Possessing a CA driver’s license or ID card:
DL/ID # _________________ Expiration Date: ____/____/____
Date Issued: ____/____/____
 Statements from an active bank account in CA; must provide statements dated prior to the residency
determination date and current statement to verify the account is still active.
Date account was opened: ____/____/____
Still Active? ____
 Petition for a divorce in CA or CA marriage license.
Date Issued: ____/____/____
 Receipts showing payment of non-resident tuition at an out-of-state institution (outside CA) with a CA permanent
home address.
 Utility bills (gas, water, power, telephone) covering the one-year period prior to the residence determination date.
Date of most recent bill: ____/____/____ Date of bill prior to the residency determination date: ____/____/____
 Documentation of public assistance, rehabilitation, unemployment, or other CA State services/benefits received
from a CA State agency covering the one-year period prior to the residence determination date.
Still current? ____
Date begun: ____/____/____
 Selective Service registration with a permanent CA address.
Date Issued: ____/____/____
__________________________________________________________________________________________________
Please list below other things you have done to justify your request to be classified as a CA resident. Physical presence in CA
solely for educational purposes does not establish residency.
____________________________________________________________________________________________________________
__________________________________________________________________________________________________________
____________________________________________________________________________________________________________

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