Residency Affidavit Form - University Of West Florida

INFORMATION FOR RESIDENCY CLASSIFICATION

Type or Print in Black Ink

A Florida ”resident for tuition purposes” is a person who has, or a dependent person whose parent or legal guardian has established and maintained legal residency in Florida for at

least twelve months. Residence in Florida must be as a bona fide domicile rather than for the purpose of maintaining a residence incident to enrollment at an institution of higher

education. To qualify as a Florida resident for tuition purposes, you must be a U.S. Citizen, permanent resident alien, or legal alien granted indefinite stay by the U.S. Citizenship &

Immigration Services. Other persons not meeting the twelve-month legal residence requirement may be classified as Florida resident for tuition purposes only if they fall within one

of the limited special categories authorized by the Florida Legislature and Board of Governors. All other persons are ineligible for classification as a Florida "resident for tuition

purposes." Living in or attending school in Florida will not, in itself, establish legal residence. Students who depend on out-of-state parents for support are presumed to be legal

residents of the same state as their parents.

NON-FLORIDA RESIDENTS

I understand that I do not qualify as a Florida resident for tuition purposes for the term for which this application is submitted and that if I should qualify for some future term it will be

necessary for me to file the required documentation prior to the beginning of the term in order to be considered for Florida residency classification.

____________________________________________________________

_____________________

Signature in ink

Date

FLORIDA RESIDENTS

This section must be completed in full if you claim Florida residency for tuition purposes.

ATTACH COPIES OF DOCUMENTATION REQUIRED

A notarized copy of your and/or your parents' most recent tax return or other documentation may be requested to establish dependence/independence.

Dependent: a person for whom 50% or more of his/her support is provided by another as defined by the Internal Revenue Service.

Independent: a person who provides more than 50% of his/her own support.

A copy of marriage certificate is required in all cases of spouse claiming partner's residency.

___A.

I am an independent person and have maintained legal residence in Florida for at least 12 months.

___B.

I am a dependent person and my parent or legal guardian has maintained legal residence in Florida for at least 12 months. (Required: copy of most recent tax return on

which you were claimed as a dependent or other proof of dependency.)

N

___C. I am a dependent person who has resided for five years with an adult relative other than my parent or legal guardian, and my relative has maintained legal residence in

Florida for at least 12 months. (Required: copy of most recent tax return on which you were claimed as a dependent, or other proof of dependency.)

___D. I am married to a person who has maintained legal residence in Florida for at least 12 months. I have now established legal residence and intend to make Florida my

N

permanent home. (Required: copy of marriage certificate, claimant's voter registration, driver license and vehicle registration.)

___E.

I was previously enrolled at a Florida state institution and classified as a Florida resident for tuition purposes. I abandoned my Florida domicile less than

12 months ago and am now re-establishing Florida legal residence.

___F.

According to U.S. Citizenship and Immigration Services, I am a permanent resident alien or other legal alien granted indefinite stay and have maintained a domicile in

Florida for at least twelve months. (Required: USCIS documentation and proof of Florida residency status.)

___G. I am a member of the armed services of the United States and I am stationed in Florida on active military duty pursuant to military orders, or whose home of record is Florida,

or I am a member's spouse or dependent child. (Required: copy of military orders or DD2058 showing home of record.)

___H. I am a full-time instructional or administrative employee employed by a Florida public school, community college or institution of higher education, or I am the

employee's spouse or dependent child. (Required: copy of employment verification.)

___I.

I am part of the Latin American/Caribbean Scholarship Program. (Required: copy of scholarship papers.)

___J.

I am a qualified beneficiary under the terms of the Florida Prepaid College Program (s.1009.988, F.S.) (Required: copy of Florida pre-paid recipient card.)

___K.

I am living on the Isthmus of Panama and have completed 12 consecutive months of college work at the F.S.U. Panama Canal Branch, or I am the student's spouse or

dependent child. (Required: copy of marriage certificate or proof of dependency.)

___L.

I am a Southern Regional Education Board's Academic Common Market graduate student. (Required: certification letter from State Coordinator.)

___M. I am a full-time employee of a state agency or political subdivision of the state whose student fees are paid by the state agency or political subdivision for the purpose of job-

related law enforcement or corrections training.

___N. I am a McKnight Fellowship recipient. (Required: verification from graduate studies.)

___O. I am an active member of the Florida National Guard who qualifies under s.250.10(7) and (8) for the tuition assistance program.

___P.

I am an active duty member (or the spouse/dependent child of the member) of the Armed Services of the United States attending a public community college or university

within 50 miles of the military establishment where the member is stationed, if such military establishment is within a county contiguous to Florida.

___Q. I am an active duty member (or the spouse or dependent child of the member) of the Canadian military residing or stationed in this state under the North American Air Defense

(NORAD) agreement, attending a public community college or university within 50 miles of the military establishment where the active duty member is stationed.

___R. I am a U.S. Citizen living outside the U.S. who is teaching at a Department of Defense Dependent School or in an American International School and who has enrolled in a

graduate level education program which leads to a Florida teaching certificate.

___S.

I am an active duty member (or spouse/dependent child of the member) of a foreign nation’s military who is serving as a liaison officer. I am residing or stationed in Florida and

attending a community college or state university within 50 miles of the military establishment where I am stationed.

PERSON CLAIMING RESIDENCY SHOULD COMPLETE THIS SECTION IN FULL.

Documents supporting the establishment of legal residence must be dated, issued, or filed 12 months before the first day of classes of the term for which a Florida resident

classification is sought. All documentation is subject to verification.

Additional documentation other than what is required above may be requested in some cases.

PLEASE PRINT.

1.

____________________________________________________________

______/______/_________

Name of Student:

2. Student’s Social Security Number:

N

3. Name of person claiming Florida residency: _______________________________________

_______________________

4. Claimant's relationship to student:

N

(_____)____________________

5. Claimant's permanent legal address:

6. Claimant's telephone number:

___________________________________________________________________________________________________________________________________

Street / P.O. Number

Apt. No.

City

State

Zip code

______/______/______

7. Date claimant began establishing legal Florida residence and domicile:

_____________

____________________

_____________

____/____/_____

8. Claimant’s voter registration:

State:

Number:

County:

Original Issue date:

____________

________________________________________

____/____/_____

9. Claimant’s driver license:

State:

Number:

Original Issue date:

____________

_____________________________________

____/____/_____

10. Claimant’s vehicle registration:

State:

Tag Number:

Original Issue date:

_______________________________________________

____/____/_____

11. Non-U.S. Citizen only:

Resident Alien Number:

Original Issue date:

I do hereby swear or affirm that the above named student meets all requirements indicated in the checked category above for classification as a Florida resident for tuition purposes.

(Copy of both sides of card required.)

I understand that a false statement in this affidavit will subject me to penalties for making a false statement pursuant to 837.06, Florida Statutes, and FBOE Rule 6C-6.001(6) FAC.

_________________________________________________________________________

_________________________

Date

Signature of person claiming Florida residency

(as listed in Item #3 above)