Fillable Petition For Oklahoma Residency Form - Admissions And Records printable pdf download

Petition For Oklahoma Residency Form - Admissions And Records

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Petition for Oklahoma Residency

 OUHSC Applicant

 Spouse Information

 Current OUHSC Student

Your Current Status:

NOTE: A check TT indicates supporting documentation must be attached. Failure to do so may delay decision

PERSONAL DATA

E-MAIL ADDRESS

LEGAL STUDENT NAME

TELEPHONE # WITH AREA CODE

Last

First

Middle

TERM/YR PETITIONING

MAILING ADDRESS

OUHSC MAJOR & EXPECTED DEGREE

Street No.

Term

Year

Major

Degree

DATE OF BIRTH

PLACE OF BIRTH

City

State

ZIP+4

Mo/Da/Yr

City

State/Country

U.S. PERMANENT RESIDENCY & NATRUALIZATION

T T

If yes, indicate date issued

Number

City & State where issued

If not a US citizen, do you hold a “permanent visa”?

Yes

If yes, provide copy of front & back of your card.

T T

Date citizenship granted

Registration Number

City & State where granted

If you are a US citizen but not by birth, provide a copy of

your passport & naturalization certification as well as the

following:

EDUCATION HISTORY

List the institutions of higher education that you have attended in the past five years

PRIVATE/PUBLIC

NAME OF INSTITUTION

CITY

STATE

FROM (MO/YR)

TO (MO/YR)

HRS

EARNED

Prior to the last five years have you attended any non-Oklahoma academic institutions of higher education?

Yes

T T

Did you pay out-of-state fees at any of these institutions?

Yes

If yes, which ones?

Provide a copy of your tuition statement or other documentation.

Indicate your primary reason for residing in Oklahoma:

Attend School

Employment

Other, specify:

NAME OF HIGH SCHOOL WHERE GRADUATED

CITY

STATE

DATE OF GRADUATION

DOMICILE

List dates & places of residence for past ten years in chronological order beginning with most recent. Provide verification of 12 consecutive months of

residence in Oklahoma prior to starting school in-state. Provide a copy of a lease agreement or warranty deed.

FROM (MO/YR)

TO (MO/YR)

STREET ADDRESS

CITY

STATE

ZIP

Indicate how many total years you have lived in Oklahoma, include from/to dates:

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