Fillable Residency Form printable pdf download

Winthrop University residency Form

Residency for Tuition-Payment Purposes for Active-Duty Personnel or Dependent Relatives

South Carolina Residency Regulations (Section 62.606.B.)

Active duty members of the United States Armed Forces and their dependents are eligible to pay in-state tuition and fees as long as they continuously claim

South Carolina as their State of Legal Residence during their military service. Additionally, certain members of the armed services and their dependent relatives

may be eligible to be charged a tuition rate less than the out-of-state rate while stationed at a military facility in South Carolina whether or not they qualify as

residents for tuition purposes under Statutory Authority: 1976 Code Sections 59- 112-10 to 59-112-100.

Documentation is required for service members who are stationed in South Carolina or for whom South Carolina is the State of Legal Residence.

Complete this form and provide the appropriate documentation listed at the bottom of the form Application for Residency for

Tuition-Payment Purposes.

Student’s Full Name:_______________________________________________________________________________________________________

Last

First

Middle

Suffix (Jr., III, etc.)

Student’s Winthrop identification number:___________________________________________________

InfoRmATIon foR The SeRvICe memBeR ThRough whom you CLAIm The mILITARy TuITIon BenefIT

1. Full name:_______________________________________________________________Relationship to student: ____________________________

2. Rank: ______________________ Serial Number: __________________________________________________ Date of birth: _____/_____/______

3. Branch of service: _______________________________________________________________________ Date of entry: ______/______/ _______

4. Is this a reserve component of indicated service?

o Yes o No

5. Current address at which service member lives: _________________________________________________________________________________

note: A post-office box address is not acceptable.

6. Is the service member on active duty?

o Yes o No

If yes, what is the permanent duty station? _________________________________

7. What is/was the effective date of this Permanent Change of Station (PCS)? _____/_____/_____

8. If the service member is assigned to a South Carolina duty station, do his/her orders provide a date on which that duty will cease?

o Yes

o No

If yes, what is that date? _____/_____/_____

9. Has the service member through whom you claim the Military Tuition Benefit received orders for permanent assignment outside South Carolina?

o Yes

o No

If yes, what is the beginning date of that assignment? ____/_____/_____

10. What is the State of Legal Residence for the service member? ________________________________

RequIReD DoCumenTATIon

Submit the applicable documentation from the list below:

Affidavits List:

1. If South Carolina is the State of Legal Residence, submit a copy of the last LES and pages 1-2 of the federal income tax return for the most recent tax year.

2. If stationed in South Carolina with a State of Legal Residence for another state, attach a copy of the most recent orders and pages 1-2 of the federal income

tax return for the most recent tax year.

I certify that all information I have provided is true to the best of my knowledge.

I hereby acknowledge that the Winthrop University may verify information provided, but may divulge the contents only as permitted under the Family Educational

Rights and Privacy Act of 1997.

______________________________________________________________________________________________________________________

Signature of student

Signature of parent or guardian

Date

(If student is under 18 years of age)