Residency Information For Tuition Purposes For Post-Traditional Students Form

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WINTHROP UNIVERSITY

RESIDENCY INFORMATION FOR IN-STATE TUITION

Return to: Office of Admissions, Winthrop University, Rock Hill South, Carolina 29733

** CLASSIFICATION AS A RESIDENT FOR TUITION PAYMENT PURPOSES IS NOT AUTOMATIC. **

All applicants who claim residency in South Carolina or entitlement to in-state tuition are required to provide the requested information.

Please complete this form in its

entirety. Incomplete forms will be returned for completion.

Additional information may be requested per SC Law

59-112.

Questions 1- 12 to be completed by all students. NOTE: please answer all questions to avoid delays in processing your residency application.

Completion of questions12- 26 is required for:

AND

all students younger than 24 years old;

students who are age 24 or older and were claimed as a dependent for the last tax year.

The application is not complete without a signature on page 3.

Name of Student: ________________________________________________________________

Winthrop ID Number: _____________________

Last

First

Middle

City of Birth: ___________________________________ State of Birth: ___________

Country of Birth: ____________________________________

Date of Birth:

Age:

(Month/Day/Year) ____________________________

___________________

Applying as (check one):  Freshman  Transfer  Second Undergraduate Degree  Other:_______________________________________

Semester you expect to begin classes:

Year: __________________________________________

Spring Summer Fall

1. What is your citizenship status?

 US Citizen

 US Permanent Resident

Date permanent residency was granted (month/day/year) ____________________________

 Foreign Citizen with valid Visa

Visa Type: __________________

 Deferred Action for Childhood Arrivals

List all addresses where you have lived for the past two years (do not use Post Office box number).

Address

Dates

______________________________________________________________________________

______________________________________

Address (Street, City, State, Zip code)

From: (month/year) To: (month/year)

______________________________________________________________________________

______________________________________

Address (Street, City, State, Zip code)

From: (month/year) To: (month/year)

______________________________________________________________________________

______________________________________

From: (month/year) To: (month/year)

Address (Street, City, State, Zip code)

______________________________________________________________________________

______________________________________

From: (month/year) To: (month/year)

Address (Street, City, State, Zip code)

3. Are you employed?

 No  Yes (If yes, provide employer’s information below)

____________________________________________________________________________________________________________________________

Employer

City, State, Zip code

Beginning date of employment

Hours per week

4. Telephone number where you can be reached: (______)______________

Can a message be left at this number?  Yes  No

5. Are you married?  Yes  No

If yes, date of marriage? ________________________________________

6. Have you been in

active

military service within the last two years?  Yes  No

If yes, State of Legal Residence _______________________

If yes, current duty station: ______________________________ Or Discharge date if applicable: Month/Day/Year______________________

7. Do you have a driver’s license?  Yes  No If yes, from what state? ________

Issue date on current license Month ______Year______________

If date is less than 12 months from your planned enrollment date (January, May or August), what is the original date of issue? Month ______Year__________

8. Do you have a motor vehicle registered in your name?  Yes  No

If yes, in what state is the vehicle registered? _________

Issue date on current motor vehicle registration Month ______Year______________

If date is less than 12 months from your planned enrollment date (January, May or August), what is the original date of issue? Month ______Year__________