Application For Oregon Border Waiver

APPLICATION FOR OREGON BORDER

WAIVER

All applicants must provide at least one piece of evidence from the list below showing they have resided in the State of Oregon for

at least 90 days before the beginning of the term to be eligible for this waiver. If you are financially dependent on your parents/

legal guardians, then your residency is based on their information. Please include a copy of your parents previous years federal

income tax form showing you were claimed and a copy of your parent’s supporting documentation from the list below.

Oregon driver’s license

Rental or lease agreement

Closing statement of a home purchase

Voter’s registration card

Vehicle registration

What quarter do you plan to start?

Summer 20 _______

Fall 20 ________

Winter 20 ________

Spring 20 ________

PLEASE PRINT

*Social Security # _________-________-_________

Assigned Student ID #_________-________-_________

Your social security number is confidential and, under a federal law called the Family Educational Rights & Privacy Act, the college will protect it from unauthorized use and/or disclosure. In compliance with

*

state/federal requirements, disclosure may be authorized for the purposes of state or federal financial aid, Hope/Lifetime Learning tax credits, academic transcripts, assessment or accountability research.

Name: __________________________________________________________________________________________________________

Last

First

M.I.

Address: _______________________________________________________________________________________________________

Street/Mailing Address

City

State

Zip

Phone number: Day (

) _____________________________

Evening (

) _____________________________

1.

Citizenship:

U.S. Citizen

Immigrant/Permanent Resident (MUST attach copy of Resident Alien Card)

Refugee/parolee or conditional entrant (MUST attach proof such as copy of I-94 departure card).

Other (please specify) _______________________________.

2.

Are you financially dependent on parents (or legal guardians)?

Yes

No

If yes, please refer to the textbox at the top of the form for required documents.

Do your parents (or legal guardians) live in the State of Oregon?

Yes

No

— If yes, how long have they continuously lived in the State of Oregon? _________

_________

Years

Months

3.

How long have you been an Oregon resident?________________

Only the following counties qualify for the Oregon Border County Waiver. Check

which county you live in.

Clackamas

Wallowa

Columbia

Morrow

Wasco

Gilliam

Sherman

Washington

Hood River

Umatilla

Multnomah

Union

Clatsop

I understand that I must maintain a permanent residence in Oregon to qualify for continued waiver of non-resident tuition. While attending Clark under this agreement, I can not qualify for Washington

based Financial Aid such as the Washington State Need Grant. I also understand that the time period which I attend under this agreement will not apply toward the 12 month period required to establish a

Washington residency. I understand that moving to Washington would nullify this application.

Student’s signature ____________________________________________________ Date _____________________________________________

FOR OFFICE USE ONLY

PLEASE RETURN TO:

ELIGIBLE

NOT ELIGIBLE

The Community Colleges of the State of Washington do not

Clark College

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RES 2, FPS 02

discriminate on the basis of race, color, creed, religion,

Office of Admissions/MS 21

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national origin, sex, sexual orientation, age, marital status,

1933 Fort Vancouver Way

disability, or status as a disabled or Vietnam era veteran.

COMMENTS:

Vancouver, WA 98663-3598