Arizona Out-Of-County Residence Affidavit Form

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SEMESTER/YEAR _______________________ 
 
      STUDENT ID #    _______________________ 
 
ARIZONA OUT‐OF‐COUNTY RESIDENCE AFFIDAVIT 
Instructions to Applicant – The Maricopa District and other established districts in the state may admit students 
from any part of this state that is not a part of an established community college district on the same conditions as 
residents. Maricopa’s enrollment process requires that students seeking the in‐county resident rate to complete 
this affidavit and submit it to the college cashier’s office upon payment of tuition. Your signature below certifies 
that the information provided on this form is accurate.  
Applicant’s Name_________________________________________ Last 4 Digits of Social Security #___________ 
 
 
(LAST)      
 (FIRST)   
(MIDDLE) 
 
Legal Address________________________________________________________, Arizona, Zip_______________ 
                          (STREET)                                                                   (CITY) 
 
 
 
(ZIP) 
 
 
Mailing Address (If Different) _______________________________________,Arizona, Zip ___________________ 
 
 
 
 
 
 
 
 
 
 
 
(ZIP) 
 
Place of Birth____________________________________ Date of Birth___________________________________ 
 
 
 
 
 
 
 
 
(MONTH)          (YEAR)          
     (AGE) 
 
County of Residence_____________________________________    How Long? ____________________________ 
 
Name of last high school attended____________________________    Location____________________________ 
 
Are you registered to vote? __________________________  If yes, where? ________________________________ 
Are you presently employed? ________________________ If yes, where?_________________________________ 
Home Telephone#_________________________________ Message Phone #_______________________________ 
 
SIGNATURE OF APPLICANT________________________________________________DATE___________________ 
 
 
 
  
TO BE COMPLETED BY PARENT OR GUARDIAN IF APPLICANT IS UNDER 18 YEARS OF AGE 
Parent or Guardian _____________________________________________ Relationship _____________________ 
Address ______________________________________________________, Arizona, Zip _____________________ 
 
 
 
 
 
 
 
 
 
 
 
(Zip) 
I am a legal resident of ___________________________________ County.  Residence established _____________ 
 
 
 
 
 
 
 
 
 
     
 
 
(YEAR) 
 
SIGNATURE OF PARENT OR GUARDIAN ______________________________________________DATE___________ 
 
 
 
 
 
 
 
 
 
 
 
SIGNATURE OF APPLICANT ________________________________________________________DATE___________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Rev 8/8/2014 

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Parent category: Legal
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