Fillable Resident Classification Request Form - Metropolitan State University printable pdf download

Resident Classiﬁ cation Request

Gateway Student Services Center

Founders Hall, Suite 100

700 East Seventh Street

Saint Paul, Minnesota 55106-5000

E-mail: gateway@metrostate.edu

Phone: 651-793-1300

Who needs to use this form?

Important Notes

How to Submit

Undergraduate and graduate students who are

Some information requested on this form

•

Be sure to include all requested documen-

being charged out-of-state tuition, and wish to

is classiﬁ ed as private. You are not legally

tation necessary to process your request.

be considered for in-state tuition.

required to provide the information, but

• Your name must be visibly printed on all

failure to do so will prevent your request from

documentation provided.

This form is not for use by international

being considered.

•

Submit this form in person or by mail to

students.

the Gateway Student Services Center.

• You will be notiﬁ ed by e-mail with the

result of your request.

Student Information

Name: _______________________________________________________________________________________________________________

Last

First

Middle

Metropolitan State student ID: ___ ___ ___ ___ ___ ___ ___ ___

Metropolitan State e-mail address: __________________________________

Phone (with area code): (H) (____)_____-_______________ (W) (____)____-_______________ (C) (____)_____-_______________

Residence(s) over the past 12 months (include address and begin/end dates of residency for each location):

Street

City

State

Zip

Begin Date / End Date

__________________________________________________________________________________________________________

ided in Minnesota for at least the past 12 months AND during that time NOT been in the state solely or primarily

Have you res

 Yes  No

for the purposes of attending a college or university?

If No:

If Yes:

Attach at least one form of supporting documentation from the list below

Review the conditions on the second page by which a non-

that veriﬁ es your physical presence in Minnesota for the past 12 months.

resident can receive the in-state tuition rate. Write your initials

Acceptable documentation includes:

on the line before the condition that applies to your

•

MN driver’s license

situation.

•

MN lease agreement

•

MN automobile registration

•

MN voter registration

•

Deed to a home in MN

•

Purchase agreement for a home in MN

•

MN income tax return (for previous year)

•

Notarized letter from a MN resident verifying that you have resided with them for the past 12 months. If you choose this option, include a

letter explaining your reasons for residing in MN.

Questions?

Contact the Gateway Student Services Center

Certiﬁ cation Area

All information provided in support of this appeal is complete and accurate to the best of my knowledge. I understand that I will be liable for unpaid

tuition from resident classiﬁ cation by means of false statements, false documentation, or concealment of facts.

Signature: _______________________________________________________________________________

Date: ____ / ____ / ______

YYYY

Ofﬁ ce Use Only

 Yes  No

Residency Request Approved:

Processed By: ___________________________________________________________________

Date: ____ / ____ / ______

YYYY

An equal opportunity educator and employer

Last updated 06/2011

Member of the Minnesota State Colleges & Universities (MnSCU) system

Resident Classification Request Form - Metropolitan State University

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