Parent Or Legal Guardian Supplemental Application For Virginia Page 2
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213.
Employment information for at least one year prior to the date for which instate tuition rates are sought:
Employer
Address
From/To (mo./yr.)
Hrs./Wk.
Salary
______________________________________________________________________________________________________
______________________________________________________________________________________________________
14.
Did you file a state income tax return with Virginia for income earned during the past two years?
Yes
No _________ Years
15.
Did you file a state income tax return with another state for income earned during the past two years?
Yes
No _____ Years
16.
What was your status when you filed your last state income tax return?
Resident
Nonresident
Did not file
17.
Are you registered to vote?
Yes
No If so, in what city/county? ____________ In what state? ____________________
When did you register to vote (mo./yr.)? ____________ Date you last voted (mo./yr.)? ____________ State ___________
18.
Do you have a valid Virginia driver’s license? Yes
No If so, when was it first issued (mo./yr.)? ______________________
Have you had a driver’s license from another state within the last five years?
Yes
No If so, when was it issued (mo./yr.)?
_____________________________________________________________________________________________________
19.
Do you operate a motor vehicle?
Yes
No In whose name is it registered? _____________________________________
In what state is it registered? ______________ What date (mo./yr.)? _____________ When will the current registration
expire (mo./yr.)? In what state was the prior registration of this vehicle? ____________________________________________
What was the expiration date (mo./yr.)? _____________________________________________________________________
20.
Do you own real property (land) in Virginia?
Yes
No If so, in what city/county? ________________________________
When did you purchase it (mo./yr.)? ________________________________________________________________________
21.
Location of checking account (city/state) __________________ Date opened ______________________________________
Location of passbook/savings account (city/state) ___________ Date opened
22.
If you have served in the military within the last five years, please provide the following information:
Date of entering Home of record on
Changes in home of record
Duty station
Expected date of
State currently claimed
State where you last
service
entering
(dates/states)
discharge
for tax purposes
paid tax on your military
income
_________________________________________________________________________________________________________________
23.
Do you have the intention to remain in Virginia indefinitely?
Yes
No To support your answer to this question, please discuss your reasons
for wanting to stay in or leave Virginia.
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
24.
You may set forth in a cover letter any further evidence of social or economic ties to Virginia that you believe should be considered in determining
the applicant’s status for payment of in-state tuition.
I hereby certify that the information given is true and accurate. I also understand that if I provide erroneous information in an attempt to evade payment
of out-of-state fees, out-of-state fees will be charged for each term attended.
Parent (mother/father)
Legal Guardian
Date
10/01
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