Fillable Application For In-State Classification printable pdf download

Application for In-State Classification

Applicants claiming in-state status for the purpose of tuition must complete this form

and return it with the application for admission to the school/program in which you are

seeking admission.

__________________________________________________________________________________________________________________________________

Last Name (Surname)

First Name (Given Name)

Middle Name (Optional)

UMB Student ID (If Known)

Have you previously attended the University of Maryland, Baltimore (UMB)? ____Yes ____No

REGISTRAR OFFICE USE ONLY

Are you currently enrolled as a student at UMB? ____Yes ____No

For which term and year have you applied? ____Fall ____Winter ____Spring ____Summer

Year:_________

Name of UMB School/Program:_____________________________________________________

Are you a citizen of the United States? ____Yes ____No (If no, complete one of the following: A, B, or C.)

A. Country of Citizenship:___________________________

Visa Type:__________________

Alien Registration No.:________________________

Date of Issue:_____________________

Date of Expiration:___________________________

B. Are you a permanent resident? ____Yes ____No _____________________________________________________________________________________

Alien Registration No.

Date of Issue

Date of Expiration

C. Other (If other, provide explanation):___________________________________________________________________________________________________

List all secondary schools, colleges/universities, professional schools and other educational institutions which you have attended or are currently attending. If you

are currently employed or have been employed within the past two years, list the name(s) of your employer(s).

Name and Location of Secondary School/High School

Dates of Attendance (MM/YYYY)

Date of Graduation (MM/YYYY)

______________________________________________

____________________________

Name and Location of College/University/Other

Dates of Attendance (MM/YYYY)

Date of Graduation (MM/YYYY)

______________________________________________

____________________________

______________________________________________

____________________________

______________________________________________

____________________________

______________________________________________

____________________________

Employer Name and Location (City, State)

Employed From/To (MM/YYYY)

Salary/Hourly Wage

Full-Time/Part-Time

_________________________________________________

____________________________

__________________

________________

_________________________________________________

____________________________

__________________

________________

If necessary, a separate sheet may be used for your responses above.

RESIDENCY INFORMATION

Do you wish to be considered for in-state tuition status?

____Yes ____No (If yes, you must complete this section of the application.)

IF ANY OF THE CATEGORIES BELOW APPLY, PLEASE CHECK THE APPROPRIATE BOX, PROVIDE REQUESTED INFORMATION AND/OR DOCUMENT.

____ I am a part-time (50%) or full-time regular employee of the University System of Maryland or, I am the spouse of, or am financially dependent upon

a parent or legal guardian who is, a regular employee of the University System of Maryland.

Please indicate relationship:__________________________________. Please attach a letter of verification from the Human Resources Office of the

campus at which you or your spouse or parent or legal guardian is employed.

____ I am a full-time active member of the U.S. Armed Forces whose home of residency is Maryland or one who resides or is stationed in Maryland, or

the spouse or a financially dependent child of such a person. Please attach a copy of your deed or lease (if applicable), or verification from the service

that you have declared Maryland as your "home of residency" (if applicable); and the most recent assignment orders. Also, please indicate date of expected

separation from the military:___________________________________.

____ I am a veteran of the United States Armed Forces residing in Maryland. Please submit a copy of your DD214. If you have a discharge category other

than honorable, please also submit a copy of your Certificate of Eligibility.

____ I am the spouse or child of a veteran of the United States Armed Forces using educational benefits under the Post-9/11 GI Bill (38 U.S.C.§ 3311(b)

(9) or 3319) and living in Maryland. Please submit a copy of the veteran’s DD214 and a copy of your Certificate of Eligibility.

____ I am eligible for in-state status considerations under the Maryland National Guard Nonresident Tuition Exemption. I am eligible because I (1) joined

or subsequently served to provide a critical military occupational skill or (2) am a member of the Air Force critical specialty code. I understand that I must

provide documentation from my company commander for consideration.

continued on next page

Rev. 07/2015

Application For In-State Classification

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