Residency Change Form

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Residency Change Form
Complete and submit this form and all required documentation to the Office of Admissions. This form must
be submitted no later than 10 days after the beginning of the term in question.
You must attach
documentation that demonstrates that you have resided in Kootenai County, Idaho for 12 months prior to
the beginning of the term with the intent of establishing a permanent domicile. A copy of your Idaho driver’s
license must be attached.
Name______________________________________________________ NIC ID__________________________
Last
First
MI
Date of Birth _____________
Term for which you are seeking residency: _____________
Permanent Address____________________________________________________________________________
Phone Number__________ County of Residence _____________Date of arrival Idaho, Kootenai County________
I am claiming residency for myself. (Completed by Student)
Please attach documentation that demonstrates that you have resided in Idaho for 12 months prior to the
beginning of the term.
(May include rent/mortgage payment, pay stubs, utility bills, bank statements, voter
registration). Also please include a copy of your driver’s license.
Please list your residence for the last 12 months
From_________ To________ Address_____________________________________________________________
From_________ To________ Address_____________________________________________________________
Please list your employment for the last 12 months
From_________ To________ Employer/address_____________________________________________________
From_________ To________ Employer/address_____________________________________________________
Please check all that apply to you and include the requested documentation.
Yes
No
Do you have a driver’s license?
From which state? _______________
I have attached a copy of my license.
Were you claimed on your parent’s tax return last year?
What percent of support do you received from your parents/guardians?
________%
I am active duty military or I have been separated form the military within the last two years.
I have included copy of orders or military separation papers (DD-214).
I graduated from a high school in the state of Idaho within the last year.
If yes, name of high school ______________________________Date of Graduation _________
Yes
No
Did you receive WUE (Western Undergraduate Exchange) tuition assistance?
If yes, what were the dates (month/day/year) of assistance? _____________

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