Domicile Affidavit Dependent - Glendale Community College printable pdf download

GLENDALE COMMUNITY COLLEGE

DOMICILE AFFIDAVIT

Dependent Student

f you are a dependent of parents who reside in Arizona, the following may apply to you:

A student whose parent(s) claims him/her as a dependent for federal and/or state income tax purposes and whose parent(s)

moved to the State of Arizona on or before the ﬁ rst day of the semester may be eligible for classiﬁ cation as in-state student

for tuition purposes. Proof of tax dependence and domicile of parent(s) in Arizona required.

NOTE: This regulation applies only to a dependent son or daughter.

If these conditions do not apply to you, please refer to the Residency Guidelines and complete the Domicile Afﬁ davit, Independent

Student form.

Parents of students who meet these conditions may complete lower portion and reverse side of this form and submit along with:

1. Copy of state and federal income tax return (for the most recent tax year) showing the student has been claimed as a

dependent.

2. Proof of parent domicile in Arizona (at least two). Any of the following may be used in determining parents domicile:

•

Proof of employment in Arizona

•

Arizona driver's license

•

Proof of purchase or rental of home or apartment occupied by parent(s)

•

Arizona voter registration

Student Name ____________________________________ Soc. Sec. # ______________________________

Student Address ____________________________________________________________________________

City, State, Zip ______________________________________________________________________________

Home Phone ______________________________________ Work Phone ______________________________

Name of Parent(s) __________________________________________________________________________

CERTIFICATION OF PARENT(S)

I certify that I meet the conditions stated above. I understand that falsiﬁ cation of information is a violation of the Student

Disciplinary Code (AR 2.5.2) and my son or daughter may be subject to disciplinary sanctions and the assessment of out-

of-state tution for the period of time for which the domicile requirements were not fuﬁ lled.

__________________________________________________________________

_________________________

Signature of Parent(s)

Date

Please submit this form and the required documents to the Enrollment Services Ofﬁ ce.

FOR OFFICE USE ONLY

_________ Approved

_________ Denied

__________________________

_____________________________________________________________

Date

Signature of College Ofﬁ cial

Domicile Affidavit Dependent - Glendale Community College