Residency Determination Worksheet - Idaho State Board Of Education Page 2
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4SECTION 3 (Independent Student - Continued)
Attach
(13) I have been physically present in Idaho for the 12 months prior to the semester for which residency is
documentation.
sought. If you check this box, you must provide substantial evidence of your presence in Idaho.
Attach
(14) I have been outside of Idaho during the past 12 months.
documentation
detailing dates and
locations
Attach proof of
(15) I am married to an Idaho resident and my spouse is classified, or is eligible for classification, as a
marriage and proof
resident for the purposes of attending an Idaho college or university.
of spouse’s
If you check this box, your spouse must provide proof of Idaho domicile (by completing SECTION 4 and
residency status.
providing all requested supporting documentation).
My spouse’s name is:__________________________________________________
(16) My spouse attends_______________________________ college/university, is classified as an Idaho
resident, and has the following ID number:
SECTION 4 (Domicile)
Domicile “means that individual's true, fixed and permanent home and place of habitation. It is the place where that individual intends
to remain, and to which that individual expects to return when that individual leaves without intending to establish a new domicile
elsewhere.” Idaho Code, § 33-3717B(1)(a).
If you are applying as a dependent student under SECTION 2, your parent /guardian must complete this section. If you are applying
as an independent student under SECTION 3, you, (or your spouse if your claim of residency is based on your spouse), must
complete this section. Do not leave any questions blank. No decision can be made unless all questions are completed and all
required documentation is submitted.
(17) This section is completed by:
(18) Date of your arrival in Idaho :
(19) Date you declared Idaho as your domicile
and abandoned all prior domiciles:
Print Name:__________________________
Month ____Day ____Year ______
Month ____Day ____Year ______
Parent
Legal Guardian
Spouse
Student
(20) Purpose for moving to Idaho:
(21) Have you lived in Idaho full-time for the 12 months prior to the semester for which residency is sought?
Yes
No
(22) List chronologically your employment and physical residence for the 12 months prior to the semester for which residency is sought.
Provide supporting documentation from employer confirming employment and hours worked, and evidence of home address such as
utility statements, rental agreements, and bank statements. Attach additional pages if necessary.
DATES OF EMPLOYMENT
LOCATION (OF
OCCUPATION
HOME ADDRESS
EMPLOYMENT)
Mo. Day Yr.
Mo. Day
Yr.
City
State
Employer
Hrs/wk
Street
City
State
From
To
From
To
From
To
From
To
Attach copies of the first and
(23)
I filed an Idaho tax return in __________ and ___________ (include last two years).
last pages of your Idaho tax
returns for prior 2 years.
If yes, attach a copy of your
(24) Have you owned a home in Idaho for the 12 months prior to the semester for which residency
deed.
is sought?
Yes
No
If yes, attach a copy of your
(25) Have you rented a home in Idaho for the 12 months prior to the semester for which residency is
rental/lease agreement.
sought?
Yes
No
(26) Have you ever registered to vote in Idaho?
Date: ______________________
Yes
No
If yes, provide copy of your
voter registration.
If yes, list date and city of voter registration.
City: _______________________
(27) Have you registered any personal property in Idaho (such as motor vehicles, RV’s, travel
If yes, attach a copy of
trailers, boats or mobile homes) that requires registration and the payment of taxes or fees?
registration. Do not attach
Yes
No
copies of vehicle title(s).
Idaho State Board of Education 10 21 2013 – Residency Determination Worksheet - 2
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