Application For In State Residency Short Form printable pdf download

Application For In State Residency Short Form

Application for In-State Residency Status-

Short Form Active Duty & Veteran

Return form to: Student Accounts

University at Buffalo

232 Capen Hall

Buffalo, NY 14260

Phone: 716-645-1800 Fax: 716-645-7771

Email:

UBstudentaccounts@buffalo.edu

Section A - Personal Information

Semester applying for:__________ UB Email:__________

Last Name:____________________ First Name:_____________

Middle initial:_____

Citizenship: US citizen_____ Other_____ If other, list Visa type:_________

If you are a Permanent Resident list your Alien Registration Number:_____________

Date issued:_____

Did you attend a NYS high school or an approved NYS program for General Equivalency Diploma (GED)

examination within 5 years of applying to the University?__________________________

U.S. Military Veterans

At any time (past or present) were you, your parent or spouse eligible for VA educational benefits? Yes_____

No_____

If yes, please continue to Section C and submit required documents along with this form.

Section B - Active Duty

Are you, your parent or spouse a member of the US Armed Forces on Active Duty?

Yes_____ No_____

Is the current duty station in New York State?

Yes_____ No_____

If you answered no, are you stationed outside of NYS with at least 90 days of aggregate

service time?

Yes_____ No_____

If no, you are ineligible for in-state tuition rates. **

If your parent or spouse is stationed outside of NYS you are ineligible

for in-state tuition. **

Please continue to Section D and submit required documents along with this form.

** If you, your parent or spouse is a member of the US Armed Forces on active duty with a

Home of Record in NYS please continue to Section D and submit required documents

along with this form

Reserve and National Guard

Have you completed Initial Active Duty for Training?

Yes_____ No_____

If yes, continue to Section D and provide required

documents If no, you are ineligible for in-state tuition rates

Last updated: 1/2017

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Application For In State Residency Short Form

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