Residency Classification Application - University Of Northern Iowa (Page 2 of 2) in pdf

Independent Student (Student is married, or has dependent, or provides own financial support.)

11. If married, please give name of spouse: ________________________________________________________________

a. Date of marriage _____________________________

b. Is your spouse a resident of Iowa?

Yes___ No___

c. Is your spouse currently enrolled at UNI?

Yes___ No___

d. Did you move because you or your spouse accept full-time employment in the state of Iowa?

Yes___ No___

e. If spouse is employed, state occupation, employer and number of hours worked each week:

______________________________________________________________________________________________

Occupation

Employer and Address

Phone No.

Hours per week

How long has your spouse been employed by the above employer? ________________________________________

f. If you are employed, please state occupation, employer and number of hours worked each week:

______________________________________________________________________________________________

Occupation

Employer and Address

Phone No.

Hours per week

If employed full-time, provide a letter from your or your spouse’s employer stating you or your spouse are

employed full-time in a permanent position and the beginning date of employment.

h. If you or your spouse are employed, did you file an Iowa Resident State Income Tax return for this last year?

Yes___ No___ (If yes, please provide a copy of your return)

i. If you did not file an Iowa State Income Tax return for this last year, indicate in which state you did file and why you

did not file in Iowa. ______________________________________________________________________________

where

reason

12. List your places of residence and primary activity engaged in for the past five years.

Dates

Location

Activity

________________________________________________________________________________________________

13. On a separate page, describe in detail the sources of support for this and the next calendar year. Include all periods of

employment, all types of loans/grants/scholarships from any source, all amounts of financial support received from

parents or other persons, and the date such support ended or will end.

14. On a separate page, state why you believe you should be classified as an Iowa resident and what steps you have taken to

establish your permanent residence in Iowa. (Be specific. You may be asked to supply documents in support of your

application, such as employment verification, tax forms, driver’s license, etc.)

I certify that the information contained in the application is true, correct and complete.

______________________________________________________

_____________________________________

Signature

Date

For Office Use Only

Action ________________________________________________________ Date ________________________________

Signature/Title University Official ________________________________________________________________________

University of Northern Iowa – June 2001

Residency Classification Application - University Of Northern Iowa Page 2

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