Residency Determination Worksheet - Idaho State Board Of Education
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4IDAHO STATE BOARD OF EDUCATION - Residency Determination Worksheet
Directions: Please print clearly and answer each question. Incomplete or illegible forms cannot be considered and will be
returned. Falsification or intentionally erroneous information is subject to penalty of perjury under the laws of the State of
Idaho. All information will be kept confidential in accordance with the Family Educational Rights and Privacy Act of 1974.
Qualifications for residency must be met prior to the opening day of the semester for which the reclassification is sought.
Complete this worksheet in full, checking all applicable boxes and attach copies of all required documentation.
This worksheet and all required documentation must be submitted by the 10th day of the semester in which
reclassification is sought. Failure to provide required documentation with the worksheet will result in denial of residency.
The requirements for residency are found at Idaho Code Title 33, Chapter 37 and IDAPA 08.01.04.
SECTION 1: General Information – Student
FOR OFFICE USE ONLY
(1) Name (Last, First, Middle):
(2) Phone Number:
(
)
Evaluator:
(4) Student ID Number:
(3) Current Address:
Dependent
Independent
Resident
Non-Resident
Date Received:
(5) E-mail Address:
(6) Semester and year for which you are seeking residency:
Effective Semester:
(7a) Name of Last High School Attended:
(7b) State:
(7c) Graduation Month and Year:
(8) Student’s country of citizenship:
If you are not a United States citizen, answer questions 9a, 9b, and 9c and attach a copy of both sides of the applicable
documentation.
(9a) Do you hold permanent or temporary resident immigration status with the United States Citizen and Immigration Services
(“USCIS”)?
Yes
No
(9b) Do you hold “refugee-parolee” or "conditional entrant" status with the USCIS?
Yes
No
(9c) Are you permanently residing in the United States under color of law?
Yes
No
(9c.1) If you answered “yes” to question 9c, attach proof that you were inspected and admitted to the United States through the
USCIS and that you have not violated the terms of your admittance.
If you are not a citizen of the United States and cannot answer yes to 9a, 9b or 9c, you cannot be classified as an Idaho
resident.
SECTION 2 (Dependent Student)
(10) One or more of my parents or court appointed legal guardians (“parent/guardian”) provide at least 50% of my financial support
and has maintained domicile in Idaho for at least 12 months prior to the semester for which I am registering.
If you check this box, your parent/guardian must provide proof of providing at least 50% of your financial support (e.g., dependent on
tax return) and provide proof of domicile in Idaho (by completing SECTION 4 and providing all requested supporting documentation).
SECTION 3 (Independent Student)
(11) I receive less than 50% of my support from my parent/guardian and have continuously resided and maintained a bona fide
domicile in Idaho primarily for purposes other than educational for the 12 months preceding the semester for which I am registering.
If you check this box, you (or your spouse, if applicable) must complete SECTION 4 and provide all requested supporting
documentation.
(12) Student's Sworn Statement:
I have not been and will not be claimed as a dependent for federal income tax purposes by any person except myself (or my
spouse, if applicable), for the current and prior 12 months, and have not received and will not receive financial assistance in cash
or in kind of an amount equal to or greater than that which would qualify me to be claimed as a dependent for federal income tax
purposes by any person except myself or my spouse during the current or prior 12 months.
Signature: _________________________________________________________
(13) Date: _________________________
Idaho State Board of Education 10 21 2013 – Residency Determination Worksheet - 1
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